Provider Demographics
NPI:1497153654
Name:MCDERMOTT, ROBERT GERARD (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GERARD
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 TUMBLEBROOK
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3714
Mailing Address - Country:US
Mailing Address - Phone:210-912-4872
Mailing Address - Fax:
Practice Address - Street 1:538 TUMBLEBROOK
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3714
Practice Address - Country:US
Practice Address - Phone:210-912-4872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health