Provider Demographics
NPI:1063959393
Name:ROLLER, ROBERT (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ROLLER
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8504 CAPITOL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-5400
Mailing Address - Country:US
Mailing Address - Phone:512-968-7402
Mailing Address - Fax:
Practice Address - Street 1:4422 PACK SADDLE PASS STE 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1644
Practice Address - Country:US
Practice Address - Phone:512-968-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77274101YM0800X
TX13448101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)