Active NPI
Mary Leigh Roberts, LPC
- Professional Counselor
- Tyler, TX
National Provider Identifier
1922032036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 16227
- Practice address
- 3110 Park Center Dr
Tyler, TX 75701-9215 - Phone
- (903) 593-9999
- Fax
- (903) 526-2679
- NPI assigned
- Jul 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 16227 | TX | Primary |
Addresses
Primary practice location
3110 Park Center Dr
Tyler, TX 75701-9215
Mailing address
PO Box 132929
Tyler, TX 75713-2929
Phone (903) 593-9999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0960213 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16227 | TX | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R2 Partners, LP | Professional | Past | Accepting new patients |
| DRM Business Health, PLLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Occupational Medicine Physician
- Tyler, TX
- NPI 1760845754
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339718400000",
"number": "1922032036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 132929",
"city": "TYLER",
"state": "TX",
"postal_code": "757132929",
"telephone_number": "903-593-9999",
"fax_number": "903-526-2679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3110 PARK CENTER DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757019215",
"telephone_number": "903-593-9999",
"fax_number": "903-526-2679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "MARY",
"middle_name": "LEIGH",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-11",
"last_updated": "2012-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "16227",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0960213",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.