Provider Demographics
NPI:1154085405
Name:BRAVE BEGINNING PSYCHOTHERAPY
Entity Type:Organization
Organization Name:BRAVE BEGINNING PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CORREIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-246-2179
Mailing Address - Street 1:750 NORTHWEST HWY APT 108
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3047
Mailing Address - Country:US
Mailing Address - Phone:619-246-2179
Mailing Address - Fax:
Practice Address - Street 1:4433 W TOUHY AVE STE 500
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1838
Practice Address - Country:US
Practice Address - Phone:224-307-6219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty