MEDICARE: DALLAS NEUROBEHAVIORAL ASSOCIATES

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	33983	TX

General Provider Information

NPI Number	:	1942504733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS NEUROBEHAVIORAL ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 910042
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-0042
Country	:	US
Telephone Number	:	214-345-7357
Fax Number	:

Provider Business Practice Location Address
First Line	:	7515 GREENVILLE AVE STE 503
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3865
Country	:	US
Telephone Number	:	214-345-7357
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. KIMBERLY DOYLE
Credential	:	PH.D.
Telephone Number	:	214-345-7357

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	01/24/2011

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