Robertson, Derek Lane

Robertson, Derek Lane is an sole proprietor health care provider with primary practice located at 516 College Ave , Fort Worth TX 76104-2238. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Robertson, Derek Lane can be contacted via phone (806) 543-6585.

Contact Information

Primary practice address
516 College Ave Fort Worth TX 76104-2238
Phone: (806) 543-6585
Fax: (817) 231-0132
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 14021 Texas

Profile Details

NPI number 1114066321
LBN Legal business name Robertson, Derek Lane
Credentials M. ED., LPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 5th, 2007
Last updated Oct 13th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114066321 NPPES
Texas MEDICAID 1131088-04
Texas MEDICAID 1131088-02

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