Healthcare Provider Details

I. General information

NPI: 1114458478
Provider Name (Legal Business Name): NEURO COG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/23/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 24TH AVE SW
NORMAN OK
73069-5106
US

IV. Provider business mailing address

510 24TH AVE SW
NORMAN OK
73069-5106
US

V. Phone/Fax

Practice location:
  • Phone: 405-329-7923
  • Fax: 405-329-8815
Mailing address:
  • Phone: 405-329-7923
  • Fax: 405-329-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3712
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number521
License Number StateOK

VIII. Authorized Official

Name: MR. RAYMOND H MCCAFFREY JR.
Title or Position: OWNER/LICENSED HEALTH SERVICE PSYCH
Credential: PH.D.
Phone: 405-329-7923