MEDICARE: CNS MEMORY CLINIC LLC

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	3656	AZ
2	103G00000X	Clinical Neuropsychologist	3656	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881087369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CNS MEMORY CLINIC LLC

Provider Business Mailing Address
First Line	:	2440 N LITCHFIELD RD STE 200
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-1664
Country	:	US
Telephone Number	:	623-977-6860
Fax Number	:	623-977-2016

Provider Business Practice Location Address
First Line	:	2440 N LITCHFIELD RD STE 200
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-1664
Country	:	US
Telephone Number	:	623-977-6860
Fax Number	:	623-977-2016

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANE A HIGGINS
Credential	:	PHD
Telephone Number	:	623-977-6860

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	02/02/2026

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Directions to “CNS MEMORY CLINIC LLC ” Practice Location

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