Provider Demographics
NPI:1508894502
Name:ROBERTS, DAN H (PHD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:H
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2562
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-2562
Mailing Address - Country:US
Mailing Address - Phone:512-388-2006
Mailing Address - Fax:512-388-5886
Practice Address - Street 1:600 ROUND ROCK WEST DR
Practice Address - Street 2:SUITE 701
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5007
Practice Address - Country:US
Practice Address - Phone:512-388-2006
Practice Address - Fax:512-388-5886
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160459OtherVALUE OPTIONS PROVIDER ID
TX098570701Medicaid
TX00G98COtherBLUE CROSS PROVIDER ID
TX160459OtherVALUE OPTIONS PROVIDER ID