Provider Demographics
NPI:1740961804
Name:CLINICAL & NEUROPSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:CLINICAL & NEUROPSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-407-8043
Mailing Address - Street 1:5512 S LEWIS AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7140
Mailing Address - Country:US
Mailing Address - Phone:918-691-0678
Mailing Address - Fax:918-712-9120
Practice Address - Street 1:5512 S LEWIS AVE STE 8
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7140
Practice Address - Country:US
Practice Address - Phone:918-691-0678
Practice Address - Fax:918-712-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty