Provider Demographics
NPI:1598355679
Name:TRI STATE NEUROPSYCHOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:TRI STATE NEUROPSYCHOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-724-6161
Mailing Address - Street 1:1208 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-6840
Mailing Address - Country:US
Mailing Address - Phone:503-724-6161
Mailing Address - Fax:
Practice Address - Street 1:1850 WARRIORS RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-3904
Practice Address - Country:US
Practice Address - Phone:412-409-9017
Practice Address - Fax:412-212-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty