Healthcare Provider Details

I. General information

NPI: 1477144384
Provider Name (Legal Business Name): BRAIN HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SINGLETREE LN STE 203
EDEN PRAIRIE MN
55344-5397
US

IV. Provider business mailing address

11800 SINGLETREE LN STE 203
EDEN PRAIRIE MN
55344-5397
US

V. Phone/Fax

Practice location:
  • Phone: 952-944-5502
  • Fax: 651-730-6657
Mailing address:
  • Phone: 952-900-1440
  • Fax: 612-568-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: YOHANCE PICKETT
Title or Position: PRESIDENT
Credential: LP
Phone: 626-354-9380