Provider Demographics
NPI:1891813119
Name:ROBERTS, JUDY (LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 YAUPON TRL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7127
Mailing Address - Country:US
Mailing Address - Phone:512-415-3510
Mailing Address - Fax:512-255-2755
Practice Address - Street 1:2005 YAUPON TRL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7127
Practice Address - Country:US
Practice Address - Phone:512-415-3510
Practice Address - Fax:512-255-2755
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional