Provider Demographics
NPI:1639487598
Name:DEVEREAUX, ROBERT L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:DEVEREAUX
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 1:9047 EXECUTIVE PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4625
Mailing Address - Country:US
Mailing Address - Phone:865-983-1899
Mailing Address - Fax:865-297-4240
Practice Address - Street 1:9047 EXECUTIVE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4625
Practice Address - Country:US
Practice Address - Phone:865-983-1899
Practice Address - Fax:865-297-4240
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3496103TC0700X
TX36518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical