Provider Demographics
NPI:1356325724
Name:ROUBOS, JAMES A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:ROUBOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 S COWLEY ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1263
Mailing Address - Country:US
Mailing Address - Phone:509-624-2621
Mailing Address - Fax:509-624-6396
Practice Address - Street 1:922 S COWLEY ST STE 6
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1263
Practice Address - Country:US
Practice Address - Phone:509-624-2621
Practice Address - Fax:509-624-6396
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB18529Medicare ID - Type UnspecifiedMEDICARE #