Healthcare Provider Details

I. General information

NPI: 1558749689
Provider Name (Legal Business Name): MARKLE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 EXPOSITION BLVD STE G12
AUSTIN TX
78703-1761
US

IV. Provider business mailing address

2630 EXPOSITION BLVD STE G12
AUSTIN TX
78703-1761
US

V. Phone/Fax

Practice location:
  • Phone: 512-766-4632
  • Fax: 512-433-6732
Mailing address:
  • Phone: 512-766-4632
  • Fax: 512-433-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number36991
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36991
License Number StateTX

VIII. Authorized Official

Name: DR. MINDA MARLENE MARKLE
Title or Position: LICENSED PSYCHOLOGIST/NEUROPSYCHOLO
Credential: M.A.PH.D.ABPP
Phone: 512-766-4632