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Clinical Neuropsychologist

Austin, Texas

Provider NPI: 1033217591

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
711 W 38TH ST BLDG. F AUSTIN, TX 78705 US
Tel: 512-458-6121  Fax: 512-452-5567

Business Mailing Address:
711 W 38TH ST BLDG. F AUSTIN, TX 78705 US
Tel: 512-458-6121  Fax: 512-452-5567

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
TX2 4175

Other Provider Identifiers:

1004970 02TX05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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