Healthcare Provider Details

I. General information

NPI: 1891308730
Provider Name (Legal Business Name): THE INSTITUTE OF NEUROPSYCHOLOGICAL HEALTHCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 07/02/2022
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 RAY WHITE RD STE 200
FORT WORTH TX
76244-9105
US

IV. Provider business mailing address

9500 RAY WHITE RD STE 200
FORT WORTH TX
76244-9105
US

V. Phone/Fax

Practice location:
  • Phone: 817-745-4567
  • Fax: 833-694-0829
Mailing address:
  • Phone: 787-407-4268
  • Fax: 833-694-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL ROSARIO NIEVES
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 682-259-4255