MEDICARE: ORLANDO NEUROPSYCHOLOGY AND COUNSELING CENTER LLC

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	103G00000X	Clinical Neuropsychologist
2	103TB0200X	Cognitive & Behavioral Psychologist
3	103TC0700X	Clinical Psychologist	PY6548	FL

General Provider Information

NPI Number	:	1548566557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO NEUROPSYCHOLOGY AND COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	5401 S KIRKMAN RD
Second Line	:	STE 680
City	:	ORLANDO
State	:	FL
Zip	:	32819-7940
Country	:	US
Telephone Number	:	866-284-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 S KIRKMAN RD
Second Line	:	STE 680
City	:	ORLANDO
State	:	FL
Zip	:	32819-7940
Country	:	US
Telephone Number	:	866-284-0211
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTJAN OLAFSSON
Credential	:	PH.D.
Telephone Number	:	866-284-0211

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	03/22/2011

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