Provider Demographics
NPI:1477144384
Name:BRAIN HEALTH GROUP LLC
Entity Type:Organization
Organization Name:BRAIN HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOHANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:626-354-9380
Mailing Address - Street 1:11800 SINGLETREE LN STE 203
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5397
Mailing Address - Country:US
Mailing Address - Phone:952-900-1440
Mailing Address - Fax:612-568-4977
Practice Address - Street 1:11800 SINGLETREE LN STE 203
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5397
Practice Address - Country:US
Practice Address - Phone:952-944-5502
Practice Address - Fax:651-730-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty