Provider Demographics
NPI:1518366285
Name:BRAINTRUST BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:BRAINTRUST BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARIAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, LLP
Authorized Official - Phone:269-303-5931
Mailing Address - Street 1:3320 TAMSIN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-4002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3320 TAMSIN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-4002
Practice Address - Country:US
Practice Address - Phone:269-303-5931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health