Healthcare Provider Details

I. General information

NPI: 1831515311
Provider Name (Legal Business Name): HARMONIZED BRAIN CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2014
Last Update Date: 09/06/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 N ACADEMY BLVD
COLORADO SPRINGS CO
80909-1507
US

IV. Provider business mailing address

5925 LEHMAN DR SUITE 5
COLORADO SPRINGS CO
80918-3425
US

V. Phone/Fax

Practice location:
  • Phone: 719-661-6422
  • Fax: 719-213-2011
Mailing address:
  • Phone: 719-661-6422
  • Fax: 719-213-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNLC0104292
License Number StateCO

VIII. Authorized Official

Name: DALLAS SHEPARD
Title or Position: OWNER/BRAIN HEALTH SPECIALIST
Credential:
Phone: 719-661-6422