1902047038 NPI number — MS. CLAUDIA JANE ROBERTS MED., LPC

Table of content: MS. CLAUDIA JANE ROBERTS MED., LPC (NPI 1902047038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902047038 NPI number — MS. CLAUDIA JANE ROBERTS MED., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
CLAUDIA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MED., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTSELL
Provider Other First Name:
CLAUDIA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M ED. LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902047038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 LAKERIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKESIDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76108-9426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-237-5300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 LAKERIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKESIDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76108-9426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-237-5300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6013 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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