Provider Demographics
NPI:1700765906
Name:ROBOLT, DESIREE NICOLE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:ROBOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 CEDAR WING CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3161
Mailing Address - Country:US
Mailing Address - Phone:832-279-7550
Mailing Address - Fax:
Practice Address - Street 1:3015 CEDAR WING CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3161
Practice Address - Country:US
Practice Address - Phone:832-279-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205877106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist