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Contact Information

MARK W ROBERTS, PhD
921 S 8TH AVE
GARRISON HALL 525 STOP 8021
POCATELLO, ID83209-0002
 Phone: 208-282-2129
 Fax: 208-282-5411
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Child & Adolescent

103TC2200X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for MARK W ROBERTS · (Male)

NPI # 1336201342
Status Active
Credentials PhD
Entity Individual
Enumeration date 12/15/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • ID License # PSY-138
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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