| Brain Dynamics Llc | |
|
746 West Spring Street South Elgin IL 60177-1424 | |
| (224) 801-2760 | |
| Not Available |
| Full Name | Brain Dynamics Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 746 West Spring Street, South Elgin, Illinois |
| Authorized Official Name and Position | Melissa Colon (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 2248012760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brain Dynamics Llc 830 W Il Route 22 # 76 Lake Zurich IL 60047-2560 Ph: (224) 801-2760 | Brain Dynamics Llc 746 West Spring Street South Elgin IL 60177-1424 Ph: (224) 801-2760 |
| NPI Number | 1194596122 |
|---|---|
| Provider Enumeration Date | 01/09/2024 |
| Last Update Date | 01/09/2024 |
| Certification Date | 12/26/2023 |
| Medicare PECOS PAC ID | 0840630588 |
|---|---|
| Medicare Enrollment ID | O20240429003166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194596122 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Melissa Ann Colon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528424512 PECOS PAC ID: 2264736123 Enrollment ID: I20160212001811 |
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