Organization Name: | BRAIN ENHANCEMENT INSTITUTE |
NPI Number: | 1750656245 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TERRY EGAN (DIRECTOR) |
Mailing Address: | 8055 W Manchester Ave Ste 720 Playa Del Rey |
State: | CA US |
Postal Code: | 902937202 |
Phone Number: | 6267979977 |
Fax Number: | 6268442977 |
NPI Enumeration Date: | 03/15/2012 |
NPI Last Update Date: | 03/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | G67163 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |