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General NPI Number Information
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NPI Number | 1609756972
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Entity Type | Organization
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Legal Business Name | BRAIN CENTRIC NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 12791 LONE TRAIL CT
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City | MOORPARK
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State | CA
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Zip | 93021-1168
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Country | US
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Telephone | 818-800-0514
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 LAKEVIEW CANYON RD STE 138
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-4028
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Country | US
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Telephone | 818-800-0514
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. SHANNEL H.K. ELHELOU
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Credential | PSY.D.
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Telephone | 818-800-0514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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