1760138028 NPI number — NEUROFEEDBACK OF CYPRESS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760138028 NPI number — NEUROFEEDBACK OF CYPRESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROFEEDBACK OF CYPRESS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760138028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25472 KIMBRO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOCKLEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-315-0386
Provider Business Mailing Address Fax Number:
832-653-6379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16712 HUFFMEISTER RD
Provider Second Line Business Practice Location Address:
BLDG 200C
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-315-0386
Provider Business Practice Location Address Fax Number:
832-653-6379
Provider Enumeration Date:
02/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNGS
Authorized Official First Name:
DAWN-PETRICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
281-315-0386

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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