Provider Demographics
NPI:1760857577
Name:BRAIN BEHAVIOR CONSULTANTS
Entity Type:Organization
Organization Name:BRAIN BEHAVIOR CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROCHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-498-9392
Mailing Address - Street 1:2220 COIT RD STE 480
Mailing Address - Street 2:PMB 304
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3762
Mailing Address - Country:US
Mailing Address - Phone:214-498-9392
Mailing Address - Fax:972-596-0238
Practice Address - Street 1:2301 OHIO DR
Practice Address - Street 2:STE. 130
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3927
Practice Address - Country:US
Practice Address - Phone:214-498-9392
Practice Address - Fax:972-596-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15435261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health