Individual
MRS. AMY FULLER ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.,L.P.C.
Contact information
Practice address
1300 AUSTIN AVE, SUITE 203, WACO, TX 76701-1830
(254) 749-5953
(254) 867-8206
Mailing address
118 WOLF LN, WACO, TX 76705-6169
(254) 867-8206
(254) 867-8206
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
15750
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
271732
COMPSYCH
—
01
—
7039LC
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
08/30/2006
Last updated
07/08/2007
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