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General NPI Number Information
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NPI Number | 1114438785
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Entity Type | Organization
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Legal Business Name | MIND THE GAP NEUROPSYCHOLOGY SERVICES PLLC
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 10621 HASKELL LN
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-8212
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Country | US
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Telephone | 602-625-1943
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Fax |
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Provider Business Mailing Address
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Address Line | 10621 HASKELL LN
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-8212
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Country | US
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Telephone | 602-625-1943
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MELANIE TALLEY
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Credential | PSYD
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Telephone | 602-625-1943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1087
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License Number State | OK
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