Provider Demographics
NPI:1508956681
Name:MASTERSON, ROBERT MARSHALL (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARSHALL
Last Name:MASTERSON
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 1:15866 FITZGERALD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-3613
Mailing Address - Country:US
Mailing Address - Phone:325-835-7020
Mailing Address - Fax:325-947-9755
Practice Address - Street 1:2307 W HARRIS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3718
Practice Address - Country:US
Practice Address - Phone:325-947-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional