Provider Demographics
NPI:1407282932
Name:ROBERTSON, TIMOTHY ROSS (MS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROSS
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5963
Mailing Address - Country:US
Mailing Address - Phone:317-509-2596
Mailing Address - Fax:317-396-0687
Practice Address - Street 1:3940 E 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5963
Practice Address - Country:US
Practice Address - Phone:317-509-2596
Practice Address - Fax:317-396-0687
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health