Healthcare Provider Details

I. General information

NPI: 1952965246
Provider Name (Legal Business Name): BRAINTRAIN4YOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 E GREENWAY PKWY STE 100-587
SCOTTSDALE AZ
85254-2045
US

IV. Provider business mailing address

PO BOX 4622
SCOTTSDALE AZ
85261-4622
US

V. Phone/Fax

Practice location:
  • Phone: 480-203-0403
  • Fax:
Mailing address:
  • Phone: 480-203-0403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. LORENE M. PETTA
Title or Position: CLINICAL PSCHOLOGIST/OWNER
Credential: PSY.D.
Phone: 480-203-0403