Provider Demographics
NPI:1114330701
Name:THE INSTITUTE FOR CLINICAL NEURSOCIENCE, PLLC
Entity Type:Organization
Organization Name:THE INSTITUTE FOR CLINICAL NEURSOCIENCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTILING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-306-0215
Mailing Address - Street 1:PO BOX 25339
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80936-5339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4425 W AIRPORT FWY
Practice Address - Street 2:SUITE 250
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5832
Practice Address - Country:US
Practice Address - Phone:817-306-0215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2998OtherSTATE LICENSE
TX21788OtherSTATE LICENSE
TX21788OtherSTATE LICENSE