| NPI | 1316664006 |
|---|---|
| Doing Business As | BRAIN DOMAIN, LLC |
| Entity Type | Organization |
| Authorized Contact | CHANELLA LATRE CLARK Owner 615-337-8709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2022-10-24 |