Provider Demographics
NPI:1427758481
Name:NEUROFEEDBACK TRAINING CLINICS, LLC
Entity type:Organization
Organization Name:NEUROFEEDBACK TRAINING CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:STURDEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:920-888-6868
Mailing Address - Street 1:425 S ADAMS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4117
Mailing Address - Country:US
Mailing Address - Phone:920-888-5961
Mailing Address - Fax:
Practice Address - Street 1:425 S ADAMS ST STE 102
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4117
Practice Address - Country:US
Practice Address - Phone:920-888-5961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty