Provider Demographics
NPI:1265891105
Name:BRAIN FUNCTION CLINIC PLLC
Entity type:Organization
Organization Name:BRAIN FUNCTION CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:CARINE
Authorized Official - Last Name:MESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-366-7890
Mailing Address - Street 1:447 S SHARON AMITY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2836
Mailing Address - Country:US
Mailing Address - Phone:704-366-7890
Mailing Address - Fax:704-366-7810
Practice Address - Street 1:447 S SHARON AMITY RD STE 130
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2836
Practice Address - Country:US
Practice Address - Phone:704-366-7890
Practice Address - Fax:704-366-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4746261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service