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General NPI Number Information
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NPI Number | 1134731367
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA NEUROPSYCHOLOGY, LLC
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 1614 MAHAN CENTER BLVD STE 104
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5475
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Country | US
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Telephone | 850-765-7292
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 THOMASVILLE RD APT C306
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City | TALLAHASSEE
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State | FL
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Zip | 32308-0797
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT PORTER
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Credential | LMHC, PHD
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Telephone | 850-631-1365
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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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 |
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License Number State |
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