Provider Demographics
NPI:1871667808
Name:AUSTIN NEUROPSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:AUSTIN NEUROPSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-637-5841
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:BLDG F2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-637-5841
Mailing Address - Fax:512-637-5997
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:BLDG F2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-637-5841
Practice Address - Fax:512-637-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXX00249Medicare PIN