| Clinical & Forensic Neuropsychology Services Llc | |
|
357 Towne Center Blvd Ste 403 Ridgeland MS 39157-4844 | |
| (601) 869-5898 | |
| (601) 589-0825 |
| Full Name | Clinical & Forensic Neuropsychology Services Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 357 Towne Center Blvd Ste 403, Ridgeland, Mississippi |
| Authorized Official Name and Position | Brian Heath Gordon (MANAGER) |
| Authorized Official Contact | 6018695898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinical & Forensic Neuropsychology Services Llc Po Box 2427 Madison MS 39130-2427 Ph: (601) 869-5898 | Clinical & Forensic Neuropsychology Services Llc 357 Towne Center Blvd Ste 403 Ridgeland MS 39157-4844 Ph: (601) 869-5898 |
| NPI Number | 1124527841 |
|---|---|
| Provider Enumeration Date | 02/08/2018 |
| Last Update Date | 02/08/2018 |
| Medicare PECOS PAC ID | 6002170644 |
|---|---|
| Medicare Enrollment ID | O20180507000716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124527841 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Brian H Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871818369 PECOS PAC ID: 3577751528 Enrollment ID: I20101217000553 |
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