Provider Demographics
NPI:1811191745
Name:MOATS, ROBERT W (PHD, JD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:MOATS
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WEST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2072
Mailing Address - Country:US
Mailing Address - Phone:512-476-0606
Mailing Address - Fax:
Practice Address - Street 1:1001 WEST AVE STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2072
Practice Address - Country:US
Practice Address - Phone:512-476-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist