Peak Performance Neurofeedback, LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

0810004027 Issued in VA

Legal business name

PEAK PERFORMANCE NEUROFEEDBACK, LLC

Practice address

13800 Coppermine Rd
Suite 183
Herndon, VA 20171-6163

Phone

(619) 540-3235

Fax

(703) 234-2213

NPI assigned

Jun 3, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Beth B Davis, PHDNPI 1245206028

Title

Psychologist/Clinical Director

Phone

(619) 540-3235

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Beth Breece Davis, PHD

  • Health Psychologist
  • Herndon, VA
  • NPI 1245206028
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472428800000",
    "number": "1275913436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13800 COPPERMINE RD",
            "address_2": "SUITE 183",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201716163",
            "telephone_number": "619-540-3235",
            "fax_number": "703-234-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 COPPERMINE RD",
            "address_2": "SUITE 183",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201716163",
            "telephone_number": "619-540-3235",
            "fax_number": "703-234-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK PERFORMANCE NEUROFEEDBACK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-03",
        "last_updated": "2016-08-29",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PSYCHOLOGIST/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "619-540-3235",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "VA",
            "license": "0810004027",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "VA",
            "license": "0810004027",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "VA",
            "license": "0810004027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parkway Pediatrics
• Priyanka N Patel
• Alfonso Luis Patron, DDS
• Emily Pavelko
• Rebecca Ann Pawlikowski, MS, CF-SLP
• Victoria Joan Pearson
• Jennifer Bischoff Pedicano, MD
• Jasmine Pennington
• Susan Perlmutter, M.D.
• Simone Perry

• Adolescent and Children Mental Health Clinic/Center in Herndon, VA
• Providers in Herndon, VA by specialty
• Adolescent and Children Mental Health Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.