Provider Demographics
NPI:1417090838
Name:ROBERT KEITH ALBISTON
Entity Type:Organization
Organization Name:ROBERT KEITH ALBISTON
Other - Org Name:ROBERT K. ALBISTON, PH.D., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALBISTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-375-1585
Mailing Address - Street 1:1002 BRADFORD WAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-3100
Mailing Address - Country:US
Mailing Address - Phone:865-376-1585
Mailing Address - Fax:865-376-1587
Practice Address - Street 1:1002 BRADFORD WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-3100
Practice Address - Country:US
Practice Address - Phone:865-376-1585
Practice Address - Fax:865-376-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0104517OtherBLUE CROSS BLUE SHIELD TN
TN3683259Medicaid
TN3683259Medicare ID - Type Unspecified