Provider Demographics
NPI:1447897913
Name:COASTAL BEND NEUROPSYCHOLOGY
Entity type:Organization
Organization Name:COASTAL BEND NEUROPSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BUTTROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:361-253-5604
Mailing Address - Street 1:4646 CORONA DR STE 258
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4320
Mailing Address - Country:US
Mailing Address - Phone:361-253-5604
Mailing Address - Fax:361-400-5558
Practice Address - Street 1:4646 CORONA DR STE 258
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4320
Practice Address - Country:US
Practice Address - Phone:361-334-0256
Practice Address - Fax:361-400-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty