Provider Demographics
NPI:1770291189
Name:LEARN HEALING BRAIN LLC
Entity type:Organization
Organization Name:LEARN HEALING BRAIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:HAYLEY
Authorized Official - Last Name:BRAINERD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:901-612-1486
Mailing Address - Street 1:1028 CRESTHAVEN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3867
Mailing Address - Country:US
Mailing Address - Phone:901-612-1486
Mailing Address - Fax:901-425-9853
Practice Address - Street 1:4646 POPLAR AVE STE 409
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4434
Practice Address - Country:US
Practice Address - Phone:901-582-7243
Practice Address - Fax:901-425-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTPPA490OtherSTATE LICENSE
UC-51980AFD-1B01-483OtherPROFESSIONAL CERTIFIED COACH
TN4706OtherLICENSE
MSPA00599OtherSTATE LICENSE
WYPA1099OtherSTATE LICENSE