Healthcare Provider Details

I. General information

NPI: 1922121425
Provider Name (Legal Business Name): CHILD NEUROPSYCHOLOGY & COUNSELING CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5232 VILLAGE CREEK DR SUITE 200
PLANO TX
75093-4437
US

IV. Provider business mailing address

5232 VILLAGE CREEK DR SUITE 200
PLANO TX
75093-4437
US

V. Phone/Fax

Practice location:
  • Phone: 972-490-5757
  • Fax: 972-250-3644
Mailing address:
  • Phone: 972-490-5757
  • Fax: 972-250-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number31374
License Number StateTX

VIII. Authorized Official

Name: DR. LINDY SYLVAN POTTINGER
Title or Position: PEDIATRIC NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 972-490-5757