MEDICARE: NEUROSKILLS INTEGRATED LEARNING AND CONSULTING, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255813143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSKILLS INTEGRATED LEARNING AND CONSULTING, PC

Provider Business Mailing Address
First Line	:	1201 N WATSON RD STE 228
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6248
Country	:	US
Telephone Number	:	682-321-7004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N WATSON RD STE 228
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6248
Country	:	US
Telephone Number	:	682-321-7004
Fax Number	:

Authorized Official
Title or Position	:	PSYD
Name	:	DR. MATHIAS NGWA
Credential	:
Telephone Number	:	682-321-7004

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	03/01/2022

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