Provider Demographics
NPI:1780872986
Name:NEUROPSYCHOLOGY SERVICES OF AUSTIN, PC
Entity type:Organization
Organization Name:NEUROPSYCHOLOGY SERVICES OF AUSTIN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANSON
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-454-7745
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-454-7745
Mailing Address - Fax:512-454-7758
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:SUITE D-3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-454-7745
Practice Address - Fax:512-454-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22727103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z614Medicare PIN