Provider Demographics
NPI:1366484396
Name:ROBERTS, MARY KATHRYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHRYN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:'KITTY'
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2524 LILLIAN MILLER PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-7206
Mailing Address - Country:US
Mailing Address - Phone:940-383-2211
Mailing Address - Fax:940-383-2741
Practice Address - Street 1:2524 LILLIAN MILLER PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7206
Practice Address - Country:US
Practice Address - Phone:940-383-2211
Practice Address - Fax:940-383-2741
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15427103TC0700X
UT5192218-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical