Healthcare Provider Details

I. General information

NPI: 1932978616
Provider Name (Legal Business Name): NEUROFIT CONNECTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 OLD APEX RD STE 118
CARY NC
27513-5365
US

IV. Provider business mailing address

1517 OLD APEX RD STE 118
CARY NC
27513-5365
US

V. Phone/Fax

Practice location:
  • Phone: 833-632-5437
  • Fax:
Mailing address:
  • Phone: 833-632-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY P. BECK
Title or Position: CO-FOUNDER / CENTER MANAGER
Credential: CHT, PH.D.
Phone: 833-632-5437