| Mind For Sports | |
|
706b W Ben White Blvd Ste 120b Austin TX 78704-7153 | |
| (512) 318-1833 | |
| (512) 852-4771 |
| Full Name | Mind For Sports |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 706b W Ben White Blvd, Austin, Texas |
| Authorized Official Name and Position | Richard O Temple (OWNER) |
| Authorized Official Contact | 5122942304 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind For Sports Po Box 145 Dripping Springs TX 78620-0145 Ph: (512) 318-1833 | Mind For Sports 706b W Ben White Blvd Ste 120b Austin TX 78704-7153 Ph: (512) 318-1833 |
| NPI Number | 1235551086 |
|---|---|
| Provider Enumeration Date | 01/14/2014 |
| Last Update Date | 01/14/2014 |
| Medicare PECOS PAC ID | 2769610609 |
|---|---|
| Medicare Enrollment ID | O20140122001415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235551086 | NPI | - | NPPES |
| 1366609265 | Other | TX | RICHARD O TEMPLE'S PERSONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 32760 (Texas) | Primary |
| Provider Name | Richard O Temple |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366609265 PECOS PAC ID: 9638307580 Enrollment ID: I20140122001656 |
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