1386443265 NPI number — COGNITIVE FUNCTION DEVELOPMENT INSTITUTE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386443265 NPI number — COGNITIVE FUNCTION DEVELOPMENT INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COGNITIVE FUNCTION DEVELOPMENT INSTITUTE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386443265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6895 E LYNX WAGON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86314-1932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-251-0851
Provider Business Mailing Address Fax Number:
928-515-2278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COGNITIVE FUNCTION DEVELOPMENT INSTITUTE
Provider Second Line Business Practice Location Address:
3250 GATEWAY BLVD, SUITE 200
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-251-0851
Provider Business Practice Location Address Fax Number:
928-515-2278
Provider Enumeration Date:
03/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
BEYST
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO / DIRECTOR OF R&D
Authorized Official Telephone Number:
507-251-0851

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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