Provider Demographics
NPI:1427375252
Name:PSYCHONEUROPLASTICITY, LLC
Entity Type:Organization
Organization Name:PSYCHONEUROPLASTICITY, LLC
Other - Org Name:PSYCHONEUROPLASTICITY (PNP) CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-434-5454
Mailing Address - Street 1:571 W MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3628
Mailing Address - Country:US
Mailing Address - Phone:972-434-5454
Mailing Address - Fax:972-420-1111
Practice Address - Street 1:571 W MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3628
Practice Address - Country:US
Practice Address - Phone:972-434-5454
Practice Address - Fax:972-420-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center