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General NPI Number Information
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NPI Number | 1629313044
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Entity Type | Organization
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Legal Business Name | PEDIATRIC NEUROPSYCHOLOGY SERVICES, PLLC
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 17770 PRESTON RD SUITE 1F
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City | DALLAS
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State | TX
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Zip | 75252-6084
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Country | US
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Telephone | 972-248-3682
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Fax |
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Provider Business Mailing Address
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Address Line | 17770 PRESTON RD SUITE 1F
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City | DALLAS
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State | TX
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Zip | 75252-6084
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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 | NEUROPSYCHOLOGIST
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Name | DR. MICHELLE LURIE
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Credential |
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Telephone | 972-248-3682
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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 | 31451
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License Number State | TX
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