Healthcare Provider Details

I. General information

NPI: 1871667808
Provider Name (Legal Business Name): AUSTIN NEUROPSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST BLDG F2
AUSTIN TX
78705-1121
US

IV. Provider business mailing address

711 W 38TH ST BLDG F2
AUSTIN TX
78705-1121
US

V. Phone/Fax

Practice location:
  • Phone: 512-637-5841
  • Fax: 512-637-5997
Mailing address:
  • Phone: 512-637-5841
  • Fax: 512-637-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BUNNER
Title or Position: OFFICER
Credential: PH.D.
Phone: 512-637-5841