=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467169003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEURO WELLNESS SOLUTIONS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2022
-----------------------------------------------------
Last Update Date | 11/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1807 SANTA RITA RD STE H213
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-4779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-413-3305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1807 SANTA RITA RD STE H213
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-4779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-413-3305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/CHIEF PSYCHOLOGIST
-----------------------------------------------------
Name | DR. REBECCA ANN SCOTT
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 925-413-3305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------