Provider Demographics
NPI:1215455670
Name:JO NEUROASSESSMENT CENTER
Entity type:Organization
Organization Name:JO NEUROASSESSMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MI-YEOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-647-0105
Mailing Address - Street 1:15335 MORRISON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1585
Mailing Address - Country:US
Mailing Address - Phone:818-647-0105
Mailing Address - Fax:
Practice Address - Street 1:15335 MORRISON ST STE 205
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-647-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20814103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty