Healthcare Provider Details

I. General information

NPI: 1417303165
Provider Name (Legal Business Name): BRAINWORKS & BE PRODUCTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3806 YELLOWSTONE DR
LAS CRUCES NM
88011-9064
US

IV. Provider business mailing address

3806 YELLOWSTONE DR
LAS CRUCES NM
88011-9064
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-4142
  • Fax:
Mailing address:
  • Phone: 575-405-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA ANN JOHNSTON
Title or Position: NEUROFEEDBACK THERAPIST & FITNESS
Credential: BCN
Phone: 575-405-4142