Provider Demographics
NPI:1548476880
Name:NEVELS, ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:NEVELS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:NEVELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MP
Mailing Address - Street 1:614 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2849
Mailing Address - Country:US
Mailing Address - Phone:601-853-3667
Mailing Address - Fax:
Practice Address - Street 1:2320 DRUSILLA LN STE E
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1495
Practice Address - Country:US
Practice Address - Phone:225-930-4530
Practice Address - Fax:225-930-4532
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS28405103T00000X, 103TC0700X
LAMP000035103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN 0945OtherTN LICENSE #
MSMS 28405OtherMS LIC #