Healthcare Provider Details

I. General information

NPI: 1619042181
Provider Name (Legal Business Name): ASSOCIATED NEURO & PSYCHOLOGICAL SPECIALTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PKWY SUITE 2-A
HENDERSON NV
89074-5885
US

IV. Provider business mailing address

1701 N GREEN VALLEY PKWY SUITE 2-A
HENDERSON NV
89074-5885
US

V. Phone/Fax

Practice location:
  • Phone: 702-650-0590
  • Fax: 702-650-0591
Mailing address:
  • Phone: 702-650-0590
  • Fax: 702-650-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number307C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number307C
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number307C
License Number StateNV

VIII. Authorized Official

Name: DR. LYNN SHERIDAN PORTER
Title or Position: CEO
Credential: PHD LCSW
Phone: 702-650-0590