Provider Demographics
NPI:1417303165
Name:BRAINWORKS & BE PRODUCTIONS
Entity Type:Organization
Organization Name:BRAINWORKS & BE PRODUCTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROFEEDBACK THERAPIST & FITNESS
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:BCN
Authorized Official - Phone:575-405-4142
Mailing Address - Street 1:3806 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9064
Mailing Address - Country:US
Mailing Address - Phone:575-405-4142
Mailing Address - Fax:
Practice Address - Street 1:3806 YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9064
Practice Address - Country:US
Practice Address - Phone:575-405-4142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Multi-Specialty