Provider Demographics
NPI:1396873014
Name:ROTON, ROBERT P JR (LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:ROTON
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 LIVELY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-1947
Mailing Address - Country:US
Mailing Address - Phone:214-770-0154
Mailing Address - Fax:
Practice Address - Street 1:3613 CEDAR SPRINGS RD # 3
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4905
Practice Address - Country:US
Practice Address - Phone:214-770-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327969703Medicaid