Provider Demographics
NPI:1508289299
Name:NEUROPSYCHOLOGY AND COGNITIVE HEALTH
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY AND COGNITIVE HEALTH
Other - Org Name:NEUROPSYCHOLOGY AND COGNITIVE HEALTH, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-903-3783
Mailing Address - Street 1:1808 RICHARDS RD #120
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3982
Mailing Address - Country:US
Mailing Address - Phone:425-502-8341
Mailing Address - Fax:425-502-8731
Practice Address - Street 1:1808 RICHARDS RD #120
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3982
Practice Address - Country:US
Practice Address - Phone:425-502-8341
Practice Address - Fax:425-502-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002466103G00000X, 103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8382822Medicaid
WA8382822Medicaid