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General NPI Number Information
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NPI Number | 1770291189
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Entity Type | Organization
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Legal Business Name | LEARN HEALING BRAIN LLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 4646 POPLAR AVE STE 409
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City | MEMPHIS
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State | TN
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Zip | 38117-4434
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Country | US
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Telephone | 901-582-7243
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Fax | 901-425-9853
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Provider Business Mailing Address
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Address Line | 1028 CRESTHAVEN RD STE 200
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City | MEMPHIS
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State | TN
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Zip | 38119-3867
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Country | US
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Telephone | 901-612-1486
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Fax | 901-425-9853
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Authorized Official
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Title or Position | CEO
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Name | MS. LEA HAYLEY BRAINERD
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Credential | PA-C
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Telephone | 901-612-1486
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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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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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