| Tailored Brain Health Pllc | |
|
717 Green Valley Rd Ste 200 Greensboro NC 27408-2156 | |
| (336) 542-1800 | |
| Not Available |
| Full Name | Tailored Brain Health Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 717 Green Valley Rd Ste 200, Greensboro, North Carolina |
| Authorized Official Name and Position | Jenna Renfroe (PROVIDER/OWNER) |
| Authorized Official Contact | 3365421800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tailored Brain Health Pllc 717 Green Valley Rd Ste 200 Greensboro NC 27408-2156 Ph: (336) 542-1800 | Tailored Brain Health Pllc 717 Green Valley Rd Ste 200 Greensboro NC 27408-2156 Ph: (336) 542-1800 |
| NPI Number | 1962081885 |
|---|---|
| Provider Enumeration Date | 04/07/2021 |
| Last Update Date | 05/16/2022 |
| Certification Date | 05/16/2022 |
| Medicare PECOS PAC ID | 7517375199 |
|---|---|
| Medicare Enrollment ID | O20210420002010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962081885 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jenna Brittany Renfroe |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043682669 PECOS PAC ID: 2365742012 Enrollment ID: I20190926003574 |
| Provider Name | Bethany Wangelin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740523463 PECOS PAC ID: 9335534338 Enrollment ID: I20220309001360 |
| Provider Name | Wing Yee Jackie Ma |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295519866 PECOS PAC ID: 3072969690 Enrollment ID: I20231101003857 |
| Provider Name | Allison Ann Campbell |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1881196103 PECOS PAC ID: 7214454412 Enrollment ID: I20250512000953 |
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