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General NPI Number Information
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NPI Number | 1700380904
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Entity Type | Organization
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Legal Business Name | THE BRAIN SPA, LLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 5200 EAST AVE
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2374
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Country | US
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Telephone | 803-605-4806
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Fax | 803-764-4880
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Provider Business Mailing Address
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Address Line | 5200 EAST AVE
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2374
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Country | US
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Telephone | 803-605-4806
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Fax | 803-764-4880
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SARAH MCVEY
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Credential | DO
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Telephone | 803-605-4806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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