Provider Demographics
NPI:1093495814
Name:BRAVE CONNECTIONS MENTAL HEALTH THERAPY, LLC
Entity Type:Organization
Organization Name:BRAVE CONNECTIONS MENTAL HEALTH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:BELMONT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-627-7818
Mailing Address - Street 1:8680 N WAYNE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-5037
Mailing Address - Country:US
Mailing Address - Phone:208-627-7818
Mailing Address - Fax:208-635-5908
Practice Address - Street 1:8680 N WAYNE DR STE A
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-5037
Practice Address - Country:US
Practice Address - Phone:208-627-7818
Practice Address - Fax:208-635-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty