| Neurocognitive Specialty Group, Pllc | |
|
112 Magnolia Estates Dr League City TX 77573-4613 | |
| (888) 606-0086 | |
| (346) 223-0296 |
| Full Name | Neurocognitive Specialty Group, Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 112 Magnolia Estates Dr, League City, Texas |
| Authorized Official Name and Position | Nicholas Wisdom (DIRECTOR/CLINICAL NEUROPSYCHOLOGIST) |
| Authorized Official Contact | 8886060086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurocognitive Specialty Group, Pllc 112 Magnolia Estates Dr League City TX 77573-4613 Ph: (888) 606-0086 | Neurocognitive Specialty Group, Pllc 112 Magnolia Estates Dr League City TX 77573-4613 Ph: (888) 606-0086 |
| NPI Number | 1346700275 |
|---|---|
| Provider Enumeration Date | 03/25/2019 |
| Last Update Date | 10/11/2023 |
| Certification Date | 10/11/2023 |
| Medicare PECOS PAC ID | 9133451297 |
|---|---|
| Medicare Enrollment ID | O20191023001459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346700275 | NPI | - | NPPES |
| Provider Name | Nicholas Wisdom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912260779 PECOS PAC ID: 9032441191 Enrollment ID: I20191031002778 |
| Provider Name | Brian Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689807240 PECOS PAC ID: 3577995604 Enrollment ID: I20191112000589 |
| Provider Name | Robert L Collins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134136450 PECOS PAC ID: 3971935727 Enrollment ID: I20191115001050 |
| Provider Name | Amy Kizer Cuellar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427068360 PECOS PAC ID: 7214347731 Enrollment ID: I20201111001928 |
| Provider Name | Rose Ann Dunn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740836113 PECOS PAC ID: 1052710456 Enrollment ID: I20210603002844 |
| Provider Name | Erin Sullivan-baca |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174103758 PECOS PAC ID: 2062816663 Enrollment ID: I20210804001069 |
| Provider Name | Brittany Danielle Walls |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447981279 PECOS PAC ID: 1850767195 Enrollment ID: I20221012000436 |
| Provider Name | Jonathan Parks Fillauer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760911564 PECOS PAC ID: 7113380783 Enrollment ID: I20240704000345 |
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