Healthcare Provider Details

I. General information

NPI: 1477419489
Provider Name (Legal Business Name): BRAIN HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E 200 S
SALT LAKE CITY UT
84111-2472
US

IV. Provider business mailing address

250 E 200 S STE 600
SALT LAKE CITY UT
84111-2472
US

V. Phone/Fax

Practice location:
  • Phone: 646-424-0451
  • Fax:
Mailing address:
  • Phone: 646-243-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MENSAH
Title or Position: NP
Credential: PMHNP-BC
Phone: 646-424-0451