Provider Demographics
NPI:1346463122
Name:NUTT, ROBERTA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:L
Last Name:NUTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13612 MIDWAY RD
Mailing Address - Street 2:SUITE 333
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4308
Mailing Address - Country:US
Mailing Address - Phone:972-934-3946
Mailing Address - Fax:972-539-9567
Practice Address - Street 1:13612 MIDWAY RD
Practice Address - Street 2:SUITE 333
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4308
Practice Address - Country:US
Practice Address - Phone:972-934-3946
Practice Address - Fax:972-539-9567
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21557103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist