Provider Demographics
NPI:1215496872
Name:NEUROSOLUTIONS
Entity type:Organization
Organization Name:NEUROSOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:432-413-2369
Mailing Address - Street 1:4500 W ILLINOIS AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5485
Mailing Address - Country:US
Mailing Address - Phone:432-413-2369
Mailing Address - Fax:
Practice Address - Street 1:4500 W ILLINOIS AVE STE 212
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5485
Practice Address - Country:US
Practice Address - Phone:432-413-2369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67370OtherLICENSE