Healthcare Provider Details

I. General information

NPI: 1215549886
Provider Name (Legal Business Name): BRAIN AND BODY INSIGHTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14960 WOODCARVER RD
COLORADO SPRINGS CO
80921-2370
US

IV. Provider business mailing address

14241 S REDWOOD RD STE 153
BLUFFDALE UT
84065-5223
US

V. Phone/Fax

Practice location:
  • Phone: 719-344-8779
  • Fax: 719-313-9210
Mailing address:
  • Phone: 801-819-8719
  • Fax: 719-313-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BECKIE M GRGICH
Title or Position: OWNER
Credential: PSY.D.
Phone: 719-344-8779