Provider Demographics
NPI:1457711251
Name:NEUROMETRICS, PLLC
Entity Type:Organization
Organization Name:NEUROMETRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-309-5124
Mailing Address - Street 1:5213 S VANDALIA AVE APT 4G
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4038
Mailing Address - Country:US
Mailing Address - Phone:210-309-5124
Mailing Address - Fax:
Practice Address - Street 1:7146 S BRADEN AVE STE 500
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6376
Practice Address - Country:US
Practice Address - Phone:210-309-5124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1248103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty