Provider Demographics
NPI:1083146716
Name:MIND HEADACHE AND NEUROLOGY PLLC
Entity Type:Organization
Organization Name:MIND HEADACHE AND NEUROLOGY PLLC
Other - Org Name:MIND NEUROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONTEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-402-9522
Mailing Address - Street 1:2043 N MASON RD STE 704
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6877
Mailing Address - Country:US
Mailing Address - Phone:281-402-9522
Mailing Address - Fax:
Practice Address - Street 1:2043 N MASON RD STE 704
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6877
Practice Address - Country:US
Practice Address - Phone:281-402-9522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ74522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty