Healthcare Provider Details

I. General information

NPI: 1164355053
Provider Name (Legal Business Name): TRAIN YOUR BRAIN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E ROYALTON RD STE 30
BROADVIEW HEIGHTS OH
44147-2858
US

IV. Provider business mailing address

3201 E ROYALTON RD STE 30
BROADVIEW HEIGHTS OH
44147-2858
US

V. Phone/Fax

Practice location:
  • Phone: 864-752-5180
  • Fax: 864-752-5180
Mailing address:
  • Phone: 864-752-5180
  • Fax: 864-752-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER DAWN BUCKS
Title or Position: OWNER/MANAGING MEMBER
Credential: PMHNP-BC
Phone: 864-752-5180