Provider Demographics
NPI:1700421955
Name:BRAVE EMBODIMENT COUNSELING LLC
Entity Type:Organization
Organization Name:BRAVE EMBODIMENT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:OTTINGER
Authorized Official - Last Name:MASSALE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-923-3033
Mailing Address - Street 1:2590 WELTON ST STE 200-1005
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3300
Mailing Address - Country:US
Mailing Address - Phone:720-222-5033
Mailing Address - Fax:
Practice Address - Street 1:2590 WELTON ST STE 200-1005
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3300
Practice Address - Country:US
Practice Address - Phone:720-923-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAVE EMBODIMENT COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-12
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty