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Clinical Neuropsychologist

Austin, Texas

Provider NPI: 1932278116

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
711 W 38TH ST STE D3 AUSTIN, TX 78705 US
Tel: 512-797-7025  Fax: 512-292-1144

Business Mailing Address:
711 W 38TH ST STE D3 AUSTIN, TX 78705 US
Tel: 512-797-7025  Fax: 512-292-1144

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
Y103T00000XBehavioral Health & Social Service Providers

Other Provider Identifiers:

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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