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General NPI Number Information
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NPI Number | 1770082745
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Entity Type | Organization
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Legal Business Name | PERFORMANCE NEUROPSYCHOLOGY PLLC
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 4645 AVON LN STE 285
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City | FRISCO
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State | TX
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Zip | 75033-1609
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Country | US
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Telephone | 972-632-0033
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Fax | 214-501-0809
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Provider Business Mailing Address
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Address Line | PO BOX 6001
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 469-400-6230
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | MARK THOMAS BARISA
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Credential | PHD
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Telephone | 469-400-6230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 34011
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 34011
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 34011
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 34011
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License Number State | TX
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