Provider Demographics
NPI:1902282759
Name:CLINICAL NEUROPSYCHOLOGY OF TEXAS, PLLC
Entity Type:Organization
Organization Name:CLINICAL NEUROPSYCHOLOGY OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD ABPP-CN
Authorized Official - Phone:800-291-1644
Mailing Address - Street 1:9643 HUEBNER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1752
Mailing Address - Country:US
Mailing Address - Phone:800-291-1644
Mailing Address - Fax:210-855-3988
Practice Address - Street 1:9643 HUEBNER RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1752
Practice Address - Country:US
Practice Address - Phone:800-291-1644
Practice Address - Fax:210-855-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36901103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty