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General NPI Number Information
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NPI Number | 1023354321
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Entity Type | Individual
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Provider Name | JUSTIN O'ROURKE PH.D., ABPP, ABCN
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Gender | Male
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 9643 HUEBNER RD STE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1752
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Country | US
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Telephone | 800-291-1644
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Fax | 210-855-3988
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Provider Business Mailing Address
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Address Line | 9643 HUEBNER RD STE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1752
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Country | US
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Telephone | 800-291-1644
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Fax | 210-855-3988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 36901
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 36901
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License Number State | TX
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