Provider Demographics
NPI:1902410715
Name:BRAIN AND BODY CONNECTIONS
Entity Type:Organization
Organization Name:BRAIN AND BODY CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:281-701-6022
Mailing Address - Street 1:8045B ANTOINE DR STE 224
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-4301
Mailing Address - Country:US
Mailing Address - Phone:877-366-5716
Mailing Address - Fax:877-781-8459
Practice Address - Street 1:1846 E INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:877-366-5716
Practice Address - Fax:877-781-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty