Provider Demographics
NPI:1174081988
Name:BRAIN MATTERS THERAPY, PLLC
Entity type:Organization
Organization Name:BRAIN MATTERS THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:276-970-9747
Mailing Address - Street 1:75 SEDGEWOOD MNR
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-9316
Mailing Address - Country:US
Mailing Address - Phone:305-432-1672
Mailing Address - Fax:
Practice Address - Street 1:546 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-1729
Practice Address - Country:US
Practice Address - Phone:276-970-9747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty