Derek Lane Robertson, M. ED., LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

14021 Issued in TX

Practice address

516 College Ave
Fort Worth, TX 76104-2238

Phone

(806) 543-6585

Fax

(817) 231-0132

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255392000000",
    "number": "1114066321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 S ADAMS ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761102609",
            "telephone_number": "806-543-6585",
            "fax_number": "817-231-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 COLLEGE AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042238",
            "telephone_number": "806-543-6585",
            "fax_number": "817-231-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "DEREK",
        "middle_name": "LANE",
        "name_prefix": "Mr.",
        "credential": "M. ED., LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2009-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "14021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1131088-04",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1131088-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert C Roberts, MD
• Shara Roberts, PHARM.D.
• Susan Merlene Roberts, DDS
• Victor Roberts, LVN
• Asha Jamilia Robertson
• Jacquenita Marie Robertson, PHARM.D
• Jana Robertson, M.D.
• Kate Lauren Robertson
• Kathleen Mary Robertson, MD
• Lauren Ashlee Robertson, PHARMD

• Mental Health Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.