Provider Demographics
NPI:1508125899
Name:A FOCUSED BRAIN, LLC
Entity Type:Organization
Organization Name:A FOCUSED BRAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:601-665-4254
Mailing Address - Street 1:6712 OLD CANTON RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1205
Mailing Address - Country:US
Mailing Address - Phone:601-665-4254
Mailing Address - Fax:
Practice Address - Street 1:6712 OLD CANTON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1205
Practice Address - Country:US
Practice Address - Phone:601-665-4254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty