Provider Demographics
NPI:1023282449
Name:ROUBICEK & THACKER
Entity type:Organization
Organization Name:ROUBICEK & THACKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROUBICEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:559-323-8484
Mailing Address - Street 1:1879 E FIR AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3861
Mailing Address - Country:US
Mailing Address - Phone:559-323-8484
Mailing Address - Fax:559-323-8686
Practice Address - Street 1:1879 E FIR AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3861
Practice Address - Country:US
Practice Address - Phone:559-323-8484
Practice Address - Fax:559-323-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty