Provider Demographics
NPI:1265941090
Name:ROBERTS, GREGORY DELL (PHD LPC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DELL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MAY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3520
Mailing Address - Country:US
Mailing Address - Phone:479-478-0211
Mailing Address - Fax:479-782-7181
Practice Address - Street 1:211 N GREENWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3463
Practice Address - Country:US
Practice Address - Phone:479-478-0211
Practice Address - Fax:479-782-7181
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPO103013101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health