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General NPI Number Information
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NPI Number | 1952965246
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Entity Type | Organization
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Legal Business Name | BRAINTRAIN4YOU LLC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 6424 E GREENWAY PKWY STE 100-587
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-2045
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Country | US
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Telephone | 480-203-0403
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4622
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City | SCOTTSDALE
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State | AZ
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Zip | 85261-4622
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Country | US
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Telephone | 480-203-0403
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSCHOLOGIST/OWNER
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Name | DR. LORENE M. PETTA
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Credential | PSY.D.
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Telephone | 480-203-0403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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