MEDICARE: THE NEUROPSYCHOLOGICAL ASSESSMENT CLINIC OF AUSTIN PLLC

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	261Q00000X	Clinic/Center
2	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1548040298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NEUROPSYCHOLOGICAL ASSESSMENT CLINIC OF AUSTIN PLLC

Provider Business Mailing Address
First Line	:	7000 N MOPAC EXPY STE 2127
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-2689
Country	:	US
Telephone Number	:	512-270-0511
Fax Number	:	512-655-9597

Provider Business Practice Location Address
First Line	:	7000 N MOPAC EXPY STE 2127
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-2689
Country	:	US
Telephone Number	:	512-270-0511
Fax Number	:	512-655-9597

Authorized Official
Title or Position	:	NEUROPSYCHOLOGIST
Name	:	DR. CRYSTAL MARIE LANTRIP
Credential	:	PHD
Telephone Number	:	512-270-0511

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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