Provider Demographics
NPI:1558994277
Name:PRANAMIND LLC
Entity Type:Organization
Organization Name:PRANAMIND LLC
Other - Org Name:PRANA MIND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:877-459-6463
Mailing Address - Street 1:459 W MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2808
Mailing Address - Country:US
Mailing Address - Phone:877-459-6463
Mailing Address - Fax:877-459-6463
Practice Address - Street 1:459 W MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2808
Practice Address - Country:US
Practice Address - Phone:877-459-6463
Practice Address - Fax:877-459-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty