Provider Demographics
NPI:1619042181
Name:ASSOCIATED NEURO & PSYCHOLOGICAL SPECIALTIES
Entity Type:Organization
Organization Name:ASSOCIATED NEURO & PSYCHOLOGICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:SHERIDAN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSW
Authorized Official - Phone:702-650-0590
Mailing Address - Street 1:1701 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5885
Mailing Address - Country:US
Mailing Address - Phone:702-650-0590
Mailing Address - Fax:702-650-0591
Practice Address - Street 1:1701 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 2-A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5885
Practice Address - Country:US
Practice Address - Phone:702-650-0590
Practice Address - Fax:702-650-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV307C101YP2500X, 103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty