Provider Demographics
NPI:1396412375
Name:BRAVE HEARTS MARRIAGE AND FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:BRAVE HEARTS MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN-VAN STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-471-3822
Mailing Address - Street 1:1404 E 1ST ST APT 10
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-8209
Mailing Address - Country:US
Mailing Address - Phone:323-471-3822
Mailing Address - Fax:
Practice Address - Street 1:1404 E 1ST ST APT 10
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-8209
Practice Address - Country:US
Practice Address - Phone:323-471-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT113632OtherBBS