Healthcare Provider Details

I. General information

NPI: 1891152088
Provider Name (Legal Business Name): BRAINPOWER NEUROPSYCHOLOGY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E MEADOW ST STE 4
FAYETTEVILLE AR
72701-5320
US

IV. Provider business mailing address

26 E MEADOW ST STE 4
FAYETTEVILLE AR
72701-5320
US

V. Phone/Fax

Practice location:
  • Phone: 479-310-0264
  • Fax: 888-633-0366
Mailing address:
  • Phone: 479-310-0264
  • Fax: 888-633-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number16-23P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberP1403037
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number16-23P
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberP1403037
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number16-23P
License Number StateAR

VIII. Authorized Official

Name: DR. JAMIE FRANK
Title or Position: OWNER
Credential: PH.D.
Phone: 479-310-0264