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General NPI Number Information
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NPI Number | 1831988633
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Entity Type | Organization
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Legal Business Name | BRAIN BODY THERAPEUTICS, PLC
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 129 HAWLEY RD
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City | SHELBURNE
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State | VT
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Zip | 05482-7507
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Country | US
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Telephone | 802-448-2347
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1001
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City | SHELBURNE
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State | VT
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Zip | 05482-1001
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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 | OWNER
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Name | CAITLIN RW KINNART
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Credential | PHD, MS, LCMHC, LADC
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Telephone | 802-448-2347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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