MEDICARE: CEREBRUM INNOVATIONS 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

General Provider Information

NPI Number	:	1801765680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEREBRUM INNOVATIONS LLC

Provider Business Mailing Address
First Line	:	5005 W LAUREL ST STE 100-2015
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3886
Country	:	US
Telephone Number	:	352-810-9365
Fax Number	:	352-450-3091

Provider Business Practice Location Address
First Line	:	2474 RUMBA CT APT 3
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-1521
Country	:	US
Telephone Number	:	352-810-9365
Fax Number	:	352-450-3091

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KENDRA TALLEY
Credential	:	LMHC
Telephone Number	:	352-810-9365

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	10/31/2025

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