Provider Demographics
NPI:1619797917
Name:NEURODIVERSITY FOUNDATION
Entity type:Organization
Organization Name:NEURODIVERSITY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-344-1678
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-0743
Mailing Address - Country:US
Mailing Address - Phone:713-344-1678
Mailing Address - Fax:
Practice Address - Street 1:15002 LAKEFAIR DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3995
Practice Address - Country:US
Practice Address - Phone:713-557-2727
Practice Address - Fax:713-936-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare