MEDICARE: HARMONIZED BRAIN CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	NLC0104292	CO
2	2472E0500X	EEG Technician

General Provider Information

NPI Number	:	1831515311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARMONIZED BRAIN CENTERS

Provider Business Mailing Address
First Line	:	5925 LEHMAN DR
Second Line	:	SUITE 5
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3425
Country	:	US
Telephone Number	:	719-661-6422
Fax Number	:	719-213-2011

Provider Business Practice Location Address
First Line	:	2149 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1507
Country	:	US
Telephone Number	:	719-661-6422
Fax Number	:	719-213-2011

Authorized Official
Title or Position	:	OWNER/BRAIN HEALTH SPECIALIST
Name	:	DALLAS SHEPARD
Credential	:
Telephone Number	:	719-661-6422

Provider Enumeration Date	:	03/09/2014
Last Update Date	:	09/06/2023

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