Provider Demographics
NPI:1932777661
Name:BRAIN PERFORMANCE CENTER
Entity Type:Organization
Organization Name:BRAIN PERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, BCN, BCB
Authorized Official - Phone:817-690-7190
Mailing Address - Street 1:8215 WESTCHESTER DR STE 243
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6122
Mailing Address - Country:US
Mailing Address - Phone:817-690-7190
Mailing Address - Fax:
Practice Address - Street 1:8215 WESTCHESTER DR STE 243
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6122
Practice Address - Country:US
Practice Address - Phone:817-690-7190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center