MEDICARE: MS. CAROLYN DENISE CLANSY PHD

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	31246	TX

General Provider Information

NPI Number	:	1821185554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN DENISE CLANSY PHD

Provider Business Mailing Address
First Line	:	8303 SOUTHWEST FWY
Second Line	:	SUITE 640
City	:	HOUSTON
State	:	TX
Zip	:	77074-1600
Country	:	US
Telephone Number	:	713-777-8633
Fax Number	:	713-777-5259

Provider Business Practice Location Address
First Line	:	8303 SOUTHWEST FWY
Second Line	:	SUITE 640
City	:	HOUSTON
State	:	TX
Zip	:	77074-1600
Country	:	US
Telephone Number	:	713-777-8633
Fax Number	:	713-777-5259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	01/10/2009

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