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General NPI Number Information
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NPI Number | 1356522288
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Entity Type | Organization
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Legal Business Name | SENIOR NEUROPSYCHOLOGICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 6225 PAPER SHELL WAY
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City | FORT WORTH
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State | TX
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Zip | 76179-9286
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Country | US
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Telephone | 817-988-1236
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Fax | 817-750-1237
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Provider Business Mailing Address
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Address Line | 6225 PAPER SHELL WAY
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City | FORT WORTH
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State | TX
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Zip | 76179-9286
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Country | US
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Telephone | 817-988-1236
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Fax | 817-750-1237
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRET G BENTZ
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Credential | PHD
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Telephone | 817-988-1236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 31579
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License Number State | TX
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