Provider Demographics
NPI:1518546480
Name:BRAVO COUNSELING & SERVICES LLC
Entity Type:Organization
Organization Name:BRAVO COUNSELING & SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKROTE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-394-3380
Mailing Address - Street 1:1057 LOCKARD RD
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-7936
Mailing Address - Country:US
Mailing Address - Phone:570-394-3380
Mailing Address - Fax:
Practice Address - Street 1:1057 LOCKARD RD
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-7936
Practice Address - Country:US
Practice Address - Phone:570-394-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health