MEDICARE: THE BRAIN CLINIC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	103TB0200X	Cognitive & Behavioral Psychologist
3	103TA0700X	Adult Development & Aging Psychologist
4	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1962351510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BRAIN CLINIC LLC

Provider Business Mailing Address
First Line	:	201 E MAIN ST STE 203
Second Line	:
City	:	ABINGDON
State	:	VA
Zip	:	24210-2903
Country	:	US
Telephone Number	:	276-289-3003
Fax Number	:	276-289-3022

Provider Business Practice Location Address
First Line	:	201 E MAIN ST STE 203
Second Line	:
City	:	ABINGDON
State	:	VA
Zip	:	24210-2903
Country	:	US
Telephone Number	:	276-289-3003
Fax Number	:	276-289-3022

Authorized Official
Title or Position	:	LPC, FOUNDER, OWNER
Name	:	KELLEY KINDER
Credential	:	LPC, FOUNDER, OWNER
Telephone Number	:	276-821-2260

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/28/2026

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Directions to “THE BRAIN CLINIC LLC ” Practice Location

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