Provider Demographics
NPI:1548498926
Name:ROYBAL, JUSTIN E
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:E
Last Name:ROYBAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 WESTBROOK LOOP # B
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1987
Mailing Address - Country:US
Mailing Address - Phone:509-822-8510
Mailing Address - Fax:
Practice Address - Street 1:1204 WESTBROOK LOOP # B
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1987
Practice Address - Country:US
Practice Address - Phone:509-822-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60102630101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor