| Doctor Name: | MR. MARK RENE DESROBERTS |
| NPI Number: | 1548414410 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A.,L.L.P. |
| License Number: | L1182507 |
| Business Practice Address: | 159 Kercheval Ave Grosse Pointe Farms, MI - 482363610 |
| Business Phone Number: | 3136402217 |
| Business Fax Number: | |
| Mailing Address: | 5425 Copley Square Rd, GRAND BLANC |
| State: | MI |
| Postal Code: | 484398743 |
| Phone Number: | 8106941008 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2008 |
| NPI Last Update Date: | 11/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | L1182507 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |