Provider Demographics
NPI:1396969341
Name:ROBERTS, THOMAS EVERETTE (LMFT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EVERETTE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 LYNDELL TER STE 150
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-6210
Mailing Address - Country:US
Mailing Address - Phone:530-759-0477
Mailing Address - Fax:530-231-0117
Practice Address - Street 1:2056 LYNDELL TER STE 150
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6210
Practice Address - Country:US
Practice Address - Phone:530-759-0477
Practice Address - Fax:530-231-0117
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35649106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist