MEDICARE: INTERNATIONAL NEUROPSY CONSULTANTS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	34982	TX

General Provider Information

NPI Number	:	1790184950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL NEUROPSY CONSULTANTS, P.A.

Provider Business Mailing Address
First Line	:	12800 PRESTON RD
Second Line	:	SUITE 101
City	:	DALLAS
State	:	TX
Zip	:	75230-1365
Country	:	US
Telephone Number	:	972-503-2780
Fax Number	:	972-503-2783

Provider Business Practice Location Address
First Line	:	12800 PRESTON RD
Second Line	:	SUITE 101
City	:	DALLAS
State	:	TX
Zip	:	75230-1365
Country	:	US
Telephone Number	:	972-503-2780
Fax Number	:	972-503-2783

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	KATRINA BELEN
Credential	:	PSYD
Telephone Number	:	972-503-2780

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	08/13/2014

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