Healthcare Provider Details

I. General information

NPI: 1336825728
Provider Name (Legal Business Name): BRAIN HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S AUTO MALL DR STE 104
ST GEORGE UT
84770-6756
US

IV. Provider business mailing address

1333 S AUTO MALL DR STE 104
ST GEORGE UT
84770-6756
US

V. Phone/Fax

Practice location:
  • Phone: 435-313-1703
  • Fax:
Mailing address:
  • Phone: 435-313-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: TREVOR GEE
Title or Position: ADMIN
Credential:
Phone: 435-313-1703