Organization
BRAIN SPACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MEDINA PHD (OWNER)
(720) 295-0357
Entity
Organization
Contact information
Practice address
4045 PECOS ST STE 150, DENVER, CO 80211-2561
(720) 907-0420
Mailing address
4045 PECOS ST STE 150, DENVER, CO 80211-2561
(720) 295-0357
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
11/20/2024
Last updated
11/20/2024
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