Provider Demographics
NPI:1568887032
Name:TARGINO, ROBERTA (LPC-TX, LMHC-FL)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:TARGINO
Suffix:
Gender:F
Credentials:LPC-TX, LMHC-FL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 GANDARA BND
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6781
Mailing Address - Country:US
Mailing Address - Phone:904-629-3776
Mailing Address - Fax:
Practice Address - Street 1:4209 GANDARA BND
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6781
Practice Address - Country:US
Practice Address - Phone:737-637-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 9483101YM0800X
TX80500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health