Provider Demographics
NPI:1134462419
Name:NEUROFEEDBACK TRAIN YOUR BRAIN
Entity Type:Organization
Organization Name:NEUROFEEDBACK TRAIN YOUR BRAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROFEEDBACK CLINICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH VAN METRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-588-7038
Mailing Address - Street 1:1400 CALLOWAY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2826
Mailing Address - Country:US
Mailing Address - Phone:661-588-7038
Mailing Address - Fax:661-588-7038
Practice Address - Street 1:1400 CALLOWAY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2826
Practice Address - Country:US
Practice Address - Phone:661-588-7038
Practice Address - Fax:661-588-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty