Provider Demographics
NPI:1194370429
Name:BRAIN HEALTH CENTER PSC
Entity Type:Organization
Organization Name:BRAIN HEALTH CENTER PSC
Other - Org Name:TMS TREATMENT CENTER PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JUDSON
Authorized Official - Last Name:GAGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-533-9190
Mailing Address - Street 1:535 W SECOND ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2183
Mailing Address - Country:US
Mailing Address - Phone:859-533-9190
Mailing Address - Fax:
Practice Address - Street 1:535 W SECOND ST STE 205
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2183
Practice Address - Country:US
Practice Address - Phone:859-533-9190
Practice Address - Fax:859-201-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty