Provider Demographics
NPI:1427202688
Name:NW NEUROPSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:NW NEUROPSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:281-890-7776
Mailing Address - Street 1:8300 CYPRESS CREEK PARKWAY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-0000
Mailing Address - Country:US
Mailing Address - Phone:281-890-2557
Mailing Address - Fax:281-890-7785
Practice Address - Street 1:8300 CYPRESS CREEK PKWY
Practice Address - Street 2:SUITE 450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5654
Practice Address - Country:US
Practice Address - Phone:281-890-7776
Practice Address - Fax:281-890-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33380103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1978520-02Medicaid