Provider Demographics
NPI:1891152088
Name:BRAINPOWER NEUROPSYCHOLOGY, PLC
Entity Type:Organization
Organization Name:BRAINPOWER NEUROPSYCHOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-310-0264
Mailing Address - Street 1:26 E MEADOW ST
Mailing Address - Street 2:STE 4
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5320
Mailing Address - Country:US
Mailing Address - Phone:479-310-0264
Mailing Address - Fax:888-633-0366
Practice Address - Street 1:26 E MEADOW ST
Practice Address - Street 2:STE 4
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5320
Practice Address - Country:US
Practice Address - Phone:479-310-0264
Practice Address - Fax:888-633-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-23P261QM0801X, 261QM0850X, 261QM0855X
ARP1403037261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR217685744Medicaid
546841Medicare UPIN