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General NPI Number Information
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NPI Number | 1427758481
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Entity Type | Organization
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Legal Business Name | NEUROFEEDBACK TRAINING CLINICS, LLC
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 425 S ADAMS ST STE 102
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City | GREEN BAY
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State | WI
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Zip | 54301-4117
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Country | US
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Telephone | 920-888-5961
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Fax |
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Provider Business Mailing Address
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Address Line | 425 S ADAMS ST STE 102
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City | GREEN BAY
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State | WI
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Zip | 54301-4117
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Country | US
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Telephone | 920-888-5961
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/PSYCHOLOGIST
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Name | ADAM M STURDEVANT
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Credential | PSYD
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Telephone | 920-888-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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