PEAK PERFORMANCE NEUROFEEDBACK, LLC (NPI# 1275913436) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275913436 |
| Entity Type | Organization |
| Organization Name | PEAK PERFORMANCE NEUROFEEDBACK, LLC |
| Practice Address |
13800 Coppermine Rd Suite 183 Herndon VA 20171-6163 |
| Practice Telephone | 6195403235 |
| Practice Fax Number | 7032342213 |
| Mailing Telephone | 6195403235 |
| Mailing Fax Number | 7032342213 |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2016-08-29 |
| Authorized Official Name | DR. BETH B DAVIS (PSYCHOLOGIST/CLINICAL DIRECTOR) |
| Authorized Official Telephone | 6195403235 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
0810004027 | VA | Ambulatory Health Care Facilities |
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
0810004027 | VA | Ambulatory Health Care Facilities |
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
0810004027 | VA | Ambulatory Health Care Facilities |
| Street Address |
13800 COPPERMINE RD SUITE 183 |
| City | HERNDON |
| State | VA |
| Zip Code | 20171-6163 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245206028 | Beth Breece Davis | Clinical Neuropsychologist | 13800 Coppermine Rd, Suite 183, Herndon, VA 20171-6163 | 2006-02-23 |
| 1265044614 | Juan P Dacosta | Non-emergency Medical Transport (VAN) | 13800 Coppermine Rd, Herndon, VA 20171-6163 | 2020-08-18 |
| 1770138554 | Bright Light Youth & Family Services,llc | Community/Behavioral Health | 13800 Coppermine Rd, 1st, 2nd, 3rd Floors, Herndon, VA 20171 | 2019-08-07 |
| 1306398003 | Ourkare, LLC | In Home Supportive Care | 13800 Coppermine Rd, Herndon, VA 20171-6163 | 2016-10-27 |
| 1659778454 | Heidi Marie King | Psychologist | 13800 Coppermine Rd, 1st Floor, Herndon, VA 20171-6163 | 2014-11-24 |
| 1124433453 | Kind-care, LLC | Technician | 13800 Coppermine Rd, Herndon, VA 20171-6163 | 2014-06-25 |
| 1245276633 | Kareem A Hinedi | Internal Medicine | 13800 Coppermine Rd, Herndon, VA 20171-6163 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417587312 | Herndon Modern Dentistry, PC | Dentist | 2537 John Milton Dr., Reston, VA 20171 | 2020-01-20 |
| 1689196529 | Susan Ngatia | Occupational Therapist | 2978 Centerville Rd., Herndon, VA 20171 | 2017-07-12 |
| 1932634375 | Angelic Home Care,llc | Home Health | 13800 Coppermine Road, Suite 175, Herndon, VA 20171 | 2017-04-24 |
| 1952855348 | Attentive Home Care Inc | Registered Nurse | 13578 Cedar Run Ln, Herndon, VA 20171 | 2016-08-15 |
| 1336531391 | Daniela Maria Querubin Mesina | Physical Therapist | 2978 Centreville Rd, Herndon, VA 20171 | 2015-02-28 |
| 1740602291 | Herndon Dental Arts At Woodland Park, Pllc | Dentist | 12973 Highland Crossing Drive, Ste B, Herndon, VA 20171 | 2014-01-16 |
| 1295165801 | Grace Greenan | Counselor | 13600 Frying Pan Road, Herndon, VA 20171 | 2013-11-18 |
| 1356770390 | Eunjoo Lee | Behavioral Analyst | 12936 Cedar Glen Lane, Herndon, VA 20171 | 2013-11-08 |
| 1043539919 | Wesam Hassen Moustafa Hussein | Internal Medicine | 13326 Horsepen Woods Lane, Herndon, VA 20171 | 2010-05-18 |
| 1740516996 | Fadi Alhrashi | Dentist | 13609 Flying Squirrel Dr, Herndon, VA 20171 | 2009-10-22 |
| Find all providers in zip 20171 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
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| 1407454515 | Always Blossom, LLC | Clinic/Center | 611 W Graham Rd, Richmond, VA 23222-4207 | 2020-10-12 |
| 1225645377 | Crescent Moon Counseling LLC | Clinic/Center | 8016 Burrundie Dr, Richmond, VA 23225-1972 | 2020-09-23 |
| 1811512007 | Schwarz Counseling and Coaching | Clinic/Center | 8109 Mechanicsville Turnpike, Suite 1c, Mechanicsville, VA 23111 | 2020-06-12 |
| 1174146708 | Nova Telemental Health | Clinic/Center | 14012 Willet Way, Gainesville, VA 20155-5915 | 2020-05-18 |
| 1659993731 | Sandstone Care Virginia, LLC | Clinic/Center | 11415 Isaac Newton Sq S, Reston, VA 20190-5005 | 2020-05-12 |
| 1306467147 | Shenandoah Creative Counseling for Children and Adolescents | Clinic/Center | 510 W Broad St Ste H, Waynesboro, VA 22980-4548 | 2020-05-04 |
| 1801449855 | Amazing Counseling LLC | Clinic/Center | 2428 Windy Pines Bnd, Virginia Beach, VA 23456-3954 | 2019-07-18 |
| 1366007460 | Absolute Mental Health Clinic LLC | Clinic/Center | 1303 Florida Ave, Woodbridge, VA 22191-3620 | 2019-05-03 |
| 1912468190 | Village Therapeutic Mentoring Services LLC | Clinic/Center | 1 W Cary St, Richmond, VA 23220-5609 | 2019-03-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.