Individual
MR. DEREK LANE ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. ED., LPC
Contact information
Practice address
516 COLLEGE AVE, FORT WORTH, TX 76104-2238
(806) 543-6585
(817) 231-0132
Mailing address
2420 S ADAMS ST, FORT WORTH, TX 76110-2609
(806) 543-6585
(817) 231-0132
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
14021
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1131088-02
—
TX
05
—
1131088-04
—
TX
Enumeration date
02/05/2007
Last updated
10/13/2009
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