Healthcare Provider Details

I. General information

NPI: 1245140508
Provider Name (Legal Business Name): BRAIN TRUST THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 REID ST
TALLAHASSEE FL
32303-6444
US

IV. Provider business mailing address

712 REID ST
TALLAHASSEE FL
32303-6444
US

V. Phone/Fax

Practice location:
  • Phone: 850-228-4725
  • Fax:
Mailing address:
  • Phone: 850-228-4725
  • 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: MR. SRIKANT REDDY KOTHUR
Title or Position: OWNER/CLINICIAN
Credential: LMHC
Phone: 850-228-4725