Provider Demographics
NPI:1912999715
Name:ROBERT F MEHL III PHD & ASSOC LLC
Entity Type:Organization
Organization Name:ROBERT F MEHL III PHD & ASSOC LLC
Other - Org Name:THE LAKEWOOD GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MEHL
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-771-3969
Mailing Address - Street 1:2237 RIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5164
Mailing Address - Country:US
Mailing Address - Phone:972-771-3969
Mailing Address - Fax:972-771-8258
Practice Address - Street 1:2237 RIDGE RD
Practice Address - Street 2:STE 101
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5164
Practice Address - Country:US
Practice Address - Phone:972-771-3969
Practice Address - Fax:972-771-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R52HMedicare PIN