Provider Demographics
NPI:1952071748
Name:BANYAN TREE MENTAL HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:BANYAN TREE MENTAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:724-241-3477
Mailing Address - Street 1:3000 VILLAGE RUN RD # 103-347
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6315
Mailing Address - Country:US
Mailing Address - Phone:724-241-3477
Mailing Address - Fax:
Practice Address - Street 1:3000 VILLAGE RUN RD # 103-347
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6315
Practice Address - Country:US
Practice Address - Phone:724-241-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty