Provider Demographics
NPI:1598306581
Name:RON L. ROBERTS, M.S., P.C.
Entity Type:Organization
Organization Name:RON L. ROBERTS, M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:903-581-0933
Mailing Address - Street 1:1121 E SOUTHEAST LOOP 323 STE 204
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9660
Mailing Address - Country:US
Mailing Address - Phone:903-581-0933
Mailing Address - Fax:903-581-3977
Practice Address - Street 1:1121 E SOUTHEAST LOOP 323 STE 204
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9660
Practice Address - Country:US
Practice Address - Phone:903-581-0933
Practice Address - Fax:903-581-3977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RON L. ROBERTS, M.S., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-01
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty