Provider Demographics
NPI:1376231068
Name:MASTERY NEUROSCIENCE TRAINING CERTIFIED LLC
Entity Type:Organization
Organization Name:MASTERY NEUROSCIENCE TRAINING CERTIFIED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:303-368-8277
Mailing Address - Street 1:1602 S PARKER RD STE 212
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2921
Mailing Address - Country:US
Mailing Address - Phone:303-368-8277
Mailing Address - Fax:
Practice Address - Street 1:1602 S PARKER RD STE 212
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2921
Practice Address - Country:US
Practice Address - Phone:303-368-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty