Provider Demographics
NPI:1407247265
Name:GROVES, ROBERT (LMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GROVES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 BAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7109
Mailing Address - Country:US
Mailing Address - Phone:707-864-0204
Mailing Address - Fax:707-864-0204
Practice Address - Street 1:2442 BAY HILL DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7109
Practice Address - Country:US
Practice Address - Phone:707-864-0204
Practice Address - Fax:707-864-0204
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist