Provider Demographics
NPI:1295082444
Name:FROM-TAPP, ROBERT L (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:FROM-TAPP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:L
Other - Last Name:TAPP
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:6024 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9414
Mailing Address - Country:US
Mailing Address - Phone:502-551-6668
Mailing Address - Fax:502-479-3561
Practice Address - Street 1:1326 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2306
Practice Address - Country:US
Practice Address - Phone:502-551-6668
Practice Address - Fax:502-479-3561
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical