Provider Demographics
NPI:1952965246
Name:BRAINTRAIN4YOU LLC
Entity Type:Organization
Organization Name:BRAINTRAIN4YOU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETTA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-203-0403
Mailing Address - Street 1:PO BOX 4622
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-4622
Mailing Address - Country:US
Mailing Address - Phone:480-203-0403
Mailing Address - Fax:
Practice Address - Street 1:6424 E GREENWAY PKWY STE 100-587
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2045
Practice Address - Country:US
Practice Address - Phone:480-203-0403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty