Provider Demographics
NPI:1619590528
Name:BRAIN TRAINING INSTITUTE LLC
Entity Type:Organization
Organization Name:BRAIN TRAINING INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-374-7935
Mailing Address - Street 1:1093 CALLE CARRILLO
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4300
Mailing Address - Country:US
Mailing Address - Phone:909-374-7935
Mailing Address - Fax:909-575-6717
Practice Address - Street 1:100 PIERRE RD STE A
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2565
Practice Address - Country:US
Practice Address - Phone:909-374-7935
Practice Address - Fax:090-575-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty