Provider Demographics
NPI:1831515311
Name:HARMONIZED BRAIN CENTERS
Entity type:Organization
Organization Name:HARMONIZED BRAIN CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BRAIN HEALTH SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-661-6422
Mailing Address - Street 1:5925 LEHMAN DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3425
Mailing Address - Country:US
Mailing Address - Phone:719-661-6422
Mailing Address - Fax:719-213-2011
Practice Address - Street 1:2149 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1507
Practice Address - Country:US
Practice Address - Phone:719-661-6422
Practice Address - Fax:719-213-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0104292251S00000X
2472E0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty