Provider Demographics
NPI:1497885776
Name:DYBALA, ROBERT E (LCSW, LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:DYBALA
Suffix:
Gender:M
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 HIGHWAY 6 S
Mailing Address - Street 2:SUITE 195
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1700
Mailing Address - Country:US
Mailing Address - Phone:281-556-0555
Mailing Address - Fax:281-556-9246
Practice Address - Street 1:1505 HIGHWAY 6 S
Practice Address - Street 2:SUITE 195
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1700
Practice Address - Country:US
Practice Address - Phone:281-556-0555
Practice Address - Fax:281-556-9246
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8539101YP2500X
TX109951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUR75703Medicare UPIN