Provider Demographics
NPI:1871638171
Name:BRAVEHEART MINISTRIES, LTD.
Entity Type:Organization
Organization Name:BRAVEHEART MINISTRIES, LTD.
Other - Org Name:BRAVEHEART COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MDIV, LPCC
Authorized Official - Phone:614-263-6272
Mailing Address - Street 1:3620 N HIGH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3611
Mailing Address - Country:US
Mailing Address - Phone:614-263-6272
Mailing Address - Fax:614-268-3949
Practice Address - Street 1:3620 N HIGH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3611
Practice Address - Country:US
Practice Address - Phone:614-263-6272
Practice Address - Fax:614-268-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1962500272OtherINDIVIDUAL NPI