MR. DEREK LANE ROBERTSON (NPI# 1114066321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114066321 |
| Entity Type | Individual |
| Full Name | MR. DEREK LANE ROBERTSON |
| Credential | M. ED., LPC |
| Practice Address |
516 College Ave Fort Worth TX 76104-2238 |
| Mailing Address |
2420 S Adams St Fort Worth TX 76110-2609 |
| Practice Telephone | 8065436585 |
| Practice Fax Number | 8172310132 |
| Mailing Telephone | 8065436585 |
| Mailing Fax Number | 8172310132 |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2009-10-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
14021 | TX | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 1131088-02 | 05 | |
| TX | 1131088-04 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720441983 | Derek Robertson | Social Worker | 441 Swartz Court, Ionia, MI 48846-1639 | 2016-04-04 |
| Street Address |
516 COLLEGE AVE |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-2238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003864356 | Janet M. Brown | Social Worker | 516 College Ave, Fort Worth, TX 76104-2238 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063013043 | Shayla H Rumsey | Counselor | 1137f Burton Hill Rd, Fort Worth, TX 76114-4530 | 2020-11-05 |
| 1356942544 | Abigail Ibitoye | Counselor | 6300 Ridglea Pl Ste 425, Fort Worth, TX 76116-5704 | 2020-11-04 |
| 1932713385 | Brooke Nicole Powell | Counselor | 1804 Glenmore Ave, Fort Worth, TX 76102-1509 | 2020-09-03 |
| 1669085254 | Heather Marie Wolf | Counselor | 429 College Ave Apt 301, Fort Worth, TX 76104-2264 | 2020-08-25 |
| 1013529361 | Michelle Mcqueen | Counselor | 8548 S Hulen St, Fort Worth, TX 76123-2741 | 2020-08-18 |
| 1871102772 | Precious Victoria Robinson | Counselor | 929 E Pulaski St, Fort Worth, TX 76104-5139 | 2020-07-27 |
| 1861010258 | Rachel Brohammer | Counselor | 4005 Ohare Ct Apt 602, Fort Worth, TX 76155-2853 | 2020-07-11 |
| 1972128288 | Traci Cocetti | Counselor | 4516 Fletcher Ave, Fort Worth, TX 76107-6214 | 2020-06-11 |
| 1285259622 | Brittany Lynn Stroud | Counselor | 3200 Riverfront Dr Ste 108, Fort Worth, TX 76107-6560 | 2020-06-11 |
| 1912529330 | Kristen Ann Mcgowen-plaga | Counselor | 12729 Homestretch Dr, Fort Worth, TX 76244-4214 | 2020-05-07 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
Please comment or provide details below to improve the information on MR. DEREK LANE ROBERTSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.