Individual
MARK WEST ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
921 S 8TH AVE, GARRISON HALL 525 STOP 8021, POCATELLO, ID 83209-0002
(208) 282-2129
(208) 282-5411
Mailing address
536 S 9TH AVE, POCATELLO, ID 83201-5311
(208) 478-4670
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY-138
ID
Other
Enumeration date
12/15/2006
Last updated
07/08/2007
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