Provider Demographics
NPI:1104392067
Name:NEUROPSYCHOLOGICAL SERVICES OF TEXARKANA PLLC
Entity type:Organization
Organization Name:NEUROPSYCHOLOGICAL SERVICES OF TEXARKANA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:903-255-0171
Mailing Address - Street 1:5411 PLAZA DR STE E
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1667
Mailing Address - Country:US
Mailing Address - Phone:903-255-0171
Mailing Address - Fax:903-255-0172
Practice Address - Street 1:5411 PLAZA DR STE E
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1667
Practice Address - Country:US
Practice Address - Phone:903-255-0171
Practice Address - Fax:903-255-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306834015OtherNEUROPSYCHOLOGIST