Provider Demographics
NPI:1548692742
Name:BRAIN SOLUTIONS PLLC
Entity type:Organization
Organization Name:BRAIN SOLUTIONS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-779-9050
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE A206
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3066
Mailing Address - Country:US
Mailing Address - Phone:480-779-9050
Mailing Address - Fax:480-717-4025
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE A206
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3066
Practice Address - Country:US
Practice Address - Phone:480-779-9050
Practice Address - Fax:480-717-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ854031Medicaid