Provider Demographics
NPI:1609664184
Name:BRAINSTORM BEHAVIORAL SERVICES L.L.C.
Entity type:Organization
Organization Name:BRAINSTORM BEHAVIORAL SERVICES L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-409-1252
Mailing Address - Street 1:2901 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2999
Mailing Address - Country:US
Mailing Address - Phone:313-409-1252
Mailing Address - Fax:
Practice Address - Street 1:2901 E 25TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2999
Practice Address - Country:US
Practice Address - Phone:313-409-1252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty