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General NPI Number Information
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NPI Number | 1942005160
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Entity Type | Organization
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Legal Business Name | NEURO NEXUS PLLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 12545 FARM HILL DR STE 400D
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City | HUNTLEY
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State | IL
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Zip | 60142-7913
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Country | US
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Telephone | 847-450-7193
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Fax |
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Provider Business Mailing Address
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Address Line | 12545 FARM HILL DR STE 400D
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City | HUNTLEY
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State | IL
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Zip | 60142-7913
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Country | US
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Telephone | 847-450-7193
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL NEUROPSYCHOLOGIST
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Name | DR. CARISSA HARVEY
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Credential | PSYD
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Telephone | 847-450-7193
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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