|
| |
|
4730 College Drive Vernon TX 76384-4009 | |
| (940) 552-9901 | |
| (940) 553-2523 |
| Full Name | |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 4730 College Drive, Vernon, Texas |
| Authorized Official Name and Position | Kristy Carr (ASSOCIATE COMMISSIONER) |
| Authorized Official Contact | 5128146942 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4110 Guadalupe St Mc-2023 Austin TX 78751-4296 Ph: (512) 206-5284 | 4730 College Drive Vernon TX 76384-4009 Ph: (940) 552-9901 |
| NPI Number | 1043314263 |
|---|---|
| Provider Enumeration Date | 09/08/2006 |
| Last Update Date | 02/22/2024 |
| Certification Date | 02/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043314263 | NPI | - | NPPES |
| 4539219 | Other | TX | PHARMACY NCPDP NUMBER |
| HH4008 | Other | TX | BCBS FORENSIC |
| 1081036-01 | Medicaid | TX | |
| 1301640-07 | Medicaid | TX | |
| HH3011 | Other | TX | BCBS ADOLESCENT |
| 0211963-01 | Medicaid | TX | |
| 1081036-02 | Medicaid | TX |