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General NPI Number Information
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NPI Number | 1538988332
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Entity Type | Organization
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Legal Business Name | BRAIN BODY HEALTH ALLIANCE LLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 02/16/2025
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Provider Practice Location Address
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Address Line | 1068 N CHURCH ST STE 102
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City | GREENVILLE
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State | SC
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Zip | 29601-1769
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Country | US
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Telephone | 864-395-7567
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8027
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City | GREENVILLE
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State | SC
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Zip | 29604-8027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ROBERT WINDSOR
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Credential | MD
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Telephone | 864-214-6766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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