Provider Demographics
NPI:1306853247
Name:MATTHEW L NANCE, PH.D.
Entity Type:Organization
Organization Name:MATTHEW L NANCE, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEMUEL
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-796-9946
Mailing Address - Street 1:7515 MAIN ST STE 605
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4515
Mailing Address - Country:US
Mailing Address - Phone:713-796-9946
Mailing Address - Fax:
Practice Address - Street 1:7515 MAIN ST STE 605
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4515
Practice Address - Country:US
Practice Address - Phone:713-796-9946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24693103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W815Medicare PIN
TXR58372Medicare UPIN