MEDICARE: VANGUARD CENTER FOR NEUROLOGICAL HEALTH

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	103T00000X	Psychologist
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1821550500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANGUARD CENTER FOR NEUROLOGICAL HEALTH

Provider Business Mailing Address
First Line	:	4240 SIGMA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4414
Country	:	US
Telephone Number	:	214-356-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	4240 SIGMA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4414
Country	:	US
Telephone Number	:	214-356-9364
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINSTRATOR
Name	:	KERRY PICKERING
Credential	:
Telephone Number	:	142-356-9364

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	04/02/2019

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