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3501 North 19th Street Waco TX 76708-2007 | |
| (245) 756-2171 | |
| (254) 745-5367 |
| Full Name | |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 3501 North 19th Street, Waco, Texas |
| Authorized Official Name and Position | Jana Johnson (ACCOUNTANT III) |
| Authorized Official Contact | 5122065284 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 149347 Austin TX 78714-9347 Ph: (512) 458-7111 | 3501 North 19th Street Waco TX 76708-2007 Ph: (245) 756-2171 |
| NPI Number | 1548273873 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 08/25/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548273873 | NPI | - | NPPES |
| 1099665-02 | Medicaid | TX | |
| 1404444-16 | Medicaid | TX |
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