Basic Information
| Provider Information | |||||||||
| NPI: | 1336706886 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADAPTIVE NEUROPSYCHOLOGY SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W CAPITOL AVE STE 1700 | ||||||||
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| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722013438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178970115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5154 STAGE RD STE 102 | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381343118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013729133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | BASSIN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 7178970115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.