| Organization Name: | BRAIN PERFORMANCE LLC |
| NPI Number: | 1013319656 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORBY A. BUBP (OWNER) |
| Mailing Address: | 3152 Maralice Dr Carmel |
| State: | IN US |
| Postal Code: | 460338726 |
| Phone Number: | 3179030088 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2014 |
| NPI Last Update Date: | 09/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 20042024A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |