Provider Demographics
NPI:1679979223
Name:THE BRAIN AND BODY HEALTH INSTITUTE, P.A.
Entity Type:Organization
Organization Name:THE BRAIN AND BODY HEALTH INSTITUTE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:VAN BOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:512-981-5801
Mailing Address - Street 1:3207 R R 620 SOUTH
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6872
Mailing Address - Country:US
Mailing Address - Phone:512-981-5801
Mailing Address - Fax:512-857-6920
Practice Address - Street 1:3207 R R 620 SOUTH
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-6872
Practice Address - Country:US
Practice Address - Phone:512-981-5801
Practice Address - Fax:512-857-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP59012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty