Healthcare Provider Details

I. General information

NPI: 1548040298
Provider Name (Legal Business Name): THE NEUROPSYCHOLOGICAL ASSESSMENT CLINIC OF AUSTIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 N MOPAC EXPY STE 2127
AUSTIN TX
78731-2689
US

IV. Provider business mailing address

7000 N MOPAC EXPY STE 2127
AUSTIN TX
78731-2689
US

V. Phone/Fax

Practice location:
  • Phone: 512-270-0511
  • Fax: 512-655-9597
Mailing address:
  • Phone: 512-270-0511
  • Fax: 512-655-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL MARIE LANTRIP
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 512-270-0511