Provider Demographics
NPI:1598124661
Name:BRAINWORKS LLC
Entity Type:Organization
Organization Name:BRAINWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-428-8008
Mailing Address - Street 1:1807 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8741
Mailing Address - Country:US
Mailing Address - Phone:859-428-8008
Mailing Address - Fax:859-286-6444
Practice Address - Street 1:101 WIND HAVEN DR STE 202A
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8035
Practice Address - Country:US
Practice Address - Phone:859-428-8008
Practice Address - Fax:859-286-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY - 1514103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty