Provider Demographics
NPI:1891936308
Name:THE BRAIN HEALTH PSYCHOTHERAPY CENTER P.C.
Entity Type:Organization
Organization Name:THE BRAIN HEALTH PSYCHOTHERAPY CENTER P.C.
Other - Org Name:BRAIN HEALTH PSYCHOTHERAPY, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303720-581-9890
Mailing Address - Street 1:1400 MAIN ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:303-666-1081
Mailing Address - Fax:303-666-1082
Practice Address - Street 1:1400 MAIN ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-666-1081
Practice Address - Fax:303-666-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9915221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty