Provider Demographics
NPI:1467747477
Name:BRAIN AND BEHAVIORAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:BRAIN AND BEHAVIORAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-918-0066
Mailing Address - Street 1:1300 CENTRAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2805
Mailing Address - Country:US
Mailing Address - Phone:505-243-0335
Mailing Address - Fax:505-216-2623
Practice Address - Street 1:1300 CENTRAL AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2805
Practice Address - Country:US
Practice Address - Phone:505-243-0335
Practice Address - Fax:505-216-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty