Provider Demographics
NPI:1760911564
Name:FILLAUER, JONATHAN PARKS
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PARKS
Last Name:FILLAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MAGNOLIA ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4613
Mailing Address - Country:US
Mailing Address - Phone:888-606-0086
Mailing Address - Fax:
Practice Address - Street 1:112 MAGNOLIA ESTATES DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4613
Practice Address - Country:US
Practice Address - Phone:888-606-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40228103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical