Provider Demographics
NPI:1700437506
Name:HEALTHY BRAIN AGING, LLC
Entity Type:Organization
Organization Name:HEALTHY BRAIN AGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-729-9610
Mailing Address - Street 1:14200 N NORTHSIGHT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3947
Mailing Address - Country:US
Mailing Address - Phone:480-729-9610
Mailing Address - Fax:480-500-8345
Practice Address - Street 1:14200 N NORTHSIGHT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3947
Practice Address - Country:US
Practice Address - Phone:480-729-9610
Practice Address - Fax:480-500-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty