Basic Information
| Provider Information | |||||||||
| NPI: | 1306259379 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PERCIPIO PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTER FOR OPTIMAL BRAIN HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5858 WESTHEIMER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770575643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134879310 | ||||||||
| FaxNumber: | 7134891719 | ||||||||
| Practice Location | |||||||||
| Address1: | 5858 WESTHEIMER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770575643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134879310 | ||||||||
| FaxNumber: | 7134891719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2014 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TAPIA | ||||||||
| AuthorizedOfficialFirstName: | ANDRES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7134879310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.H.D | ||||||||
| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 66505 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.