Provider Demographics
NPI:1710330444
Name:TEXAS CENTER FOR NEUROPSYCHOLOGY, P.A.
Entity Type:Organization
Organization Name:TEXAS CENTER FOR NEUROPSYCHOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-0225
Mailing Address - Street 1:2503 BUDDY OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5427
Mailing Address - Country:US
Mailing Address - Phone:956-631-6109
Mailing Address - Fax:956-631-6125
Practice Address - Street 1:2503 BUDDY OWENS AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5427
Practice Address - Country:US
Practice Address - Phone:956-631-6109
Practice Address - Fax:956-631-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36112103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty