Healthcare Provider Details

I. General information

NPI: 1902282759
Provider Name (Legal Business Name): CLINICAL NEUROPSYCHOLOGY OF TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 09/08/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9643 HUEBNER RD STE 103
SAN ANTONIO TX
78240-1752
US

IV. Provider business mailing address

9643 HUEBNER RD STE 103
SAN ANTONIO TX
78240-1752
US

V. Phone/Fax

Practice location:
  • Phone: 800-291-1644
  • Fax: 210-855-3988
Mailing address:
  • Phone: 800-291-1644
  • Fax: 210-855-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36901
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number36901
License Number StateTX

VIII. Authorized Official

Name: DR. JUSTIN O'ROURKE
Title or Position: OWNER / NEUROPSYCHOLOGIST
Credential: PH.D. ABPP-CN
Phone: 800-291-1644