MEDICARE: BANYAN TREE MENTAL HEALTH & WELLNESS 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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1952071748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANYAN TREE MENTAL HEALTH & WELLNESS LLC

Provider Business Mailing Address
First Line	:	3000 VILLAGE RUN RD # 103-347
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-6315
Country	:	US
Telephone Number	:	724-241-3477
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 VILLAGE RUN RD # 103-347
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-6315
Country	:	US
Telephone Number	:	724-241-3477
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. JASON BRAUN
Credential	:	PSYD
Telephone Number	:	724-241-3477

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/14/2021

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