Provider Demographics
NPI:1427490457
Name:ROBERTS, WILLIAM EDWARD
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3395
Mailing Address - Country:US
Mailing Address - Phone:931-461-0290
Mailing Address - Fax:931-461-0209
Practice Address - Street 1:207 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3395
Practice Address - Country:US
Practice Address - Phone:931-461-0290
Practice Address - Fax:931-461-0209
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health