Healthcare Provider Details

I. General information

NPI: 1568252757
Provider Name (Legal Business Name): DFW NEUROPSYCHOLOGY CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E JOHN CARPENTER FWY STE 273
IRVING TX
75062-4319
US

IV. Provider business mailing address

600 E JOHN CARPENTER FWY STE 273
IRVING TX
75062-4319
US

V. Phone/Fax

Practice location:
  • Phone: 469-444-3226
  • Fax: 469-208-0240
Mailing address:
  • Phone: 469-444-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RENJAN ROY MATHEW
Title or Position: OWNER
Credential: PHD.
Phone: 469-585-5393