| Cns Memory Clinic Llc | |
|
2440 N Litchfield Rd Ste 200 Goodyear AZ 85395-1664 | |
| (623) 977-6860 | |
| (623) 977-2016 |
| Full Name | Cns Memory Clinic Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 2440 N Litchfield Rd Ste 200, Goodyear, Arizona |
| Authorized Official Name and Position | Dane A Higgins (OWNER) |
| Authorized Official Contact | 6239776860 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cns Memory Clinic Llc 2440 N Litchfield Rd Ste 200 Goodyear AZ 85395-1664 Ph: (623) 977-6860 | Cns Memory Clinic Llc 2440 N Litchfield Rd Ste 200 Goodyear AZ 85395-1664 Ph: (623) 977-6860 |
| NPI Number | 1881087369 |
|---|---|
| Provider Enumeration Date | 03/09/2015 |
| Last Update Date | 10/19/2020 |
| Certification Date | 10/19/2020 |
| Medicare PECOS PAC ID | 2961775895 |
|---|---|
| Medicare Enrollment ID | O20170829001014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881087369 | NPI | - | NPPES |
| 874322 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 3656 (Arizona) | Primary |
| 103T00000X | Psychologist | 3656 (Arizona) | Secondary |
| Provider Name | Dane A Higgins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023089034 PECOS PAC ID: 6800862079 Enrollment ID: I20040908001489 |
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