Provider Demographics
NPI:1336706886
Name:ADAPTIVE NEUROPSYCHOLOGY SERVICES, PLLC
Entity type:Organization
Organization Name:ADAPTIVE NEUROPSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:BASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-897-0115
Mailing Address - Street 1:400 W CAPITOL AVE STE 1700
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3438
Mailing Address - Country:US
Mailing Address - Phone:717-897-0115
Mailing Address - Fax:
Practice Address - Street 1:5154 STAGE RD STE 102
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3118
Practice Address - Country:US
Practice Address - Phone:901-372-9133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty