MEDICARE: TRAUMA RECOVERY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1033916721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA RECOVERY SERVICES, LLC

Provider Business Mailing Address
First Line	:	1467 SISKIYOU BLVD # 517
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2336
Country	:	US
Telephone Number	:	541-200-5743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 SISKIYOU BLVD
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2400
Country	:	US
Telephone Number	:	541-200-5743
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	BRYNNE JOHANNSEN
Credential	:	PHD
Telephone Number	:	541-200-5743

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	04/14/2026

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