Provider Demographics
NPI:1114438785
Name:MIND THE GAP NEUROPSYCHOLOGY SERVICES PLLC
Entity Type:Organization
Organization Name:MIND THE GAP NEUROPSYCHOLOGY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:602-625-1943
Mailing Address - Street 1:10621 HASKELL LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-8212
Mailing Address - Country:US
Mailing Address - Phone:602-625-1943
Mailing Address - Fax:
Practice Address - Street 1:10621 HASKELL LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-8212
Practice Address - Country:US
Practice Address - Phone:602-625-1943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1087103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty