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:
Health care specialties
Specialty | Code | License # | 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 15 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1114066321 | NPPES |
Texas | MEDICAID | 1131088-04 | |
Texas | MEDICAID | 1131088-02 |
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