Provider Demographics
NPI:1710909015
Name:ZACHARY, ROBERT A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ZACHARY
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 1:21 LYNN BATTS STE 11
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3079
Mailing Address - Country:US
Mailing Address - Phone:210-829-1994
Mailing Address - Fax:210-829-8788
Practice Address - Street 1:21 LYNN BATTS STE 11
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3079
Practice Address - Country:US
Practice Address - Phone:210-829-1994
Practice Address - Fax:210-829-8788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical