Provider Demographics
NPI:1821560970
Name:BRAVE JOURNEY PLLC
Entity Type:Organization
Organization Name:BRAVE JOURNEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTHULY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-655-0980
Mailing Address - Street 1:314 1ST ST E STE 204
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-2100
Mailing Address - Country:US
Mailing Address - Phone:630-219-8019
Mailing Address - Fax:
Practice Address - Street 1:314 1ST ST E STE 204
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2100
Practice Address - Country:US
Practice Address - Phone:630-219-8019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty