Provider Demographics
NPI:1922738319
Name:BRAVE SPACES HEALTH AND WELLNESS PLLC
Entity Type:Organization
Organization Name:BRAVE SPACES HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WORFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-568-5882
Mailing Address - Street 1:820 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-8441
Mailing Address - Country:US
Mailing Address - Phone:970-568-5882
Mailing Address - Fax:
Practice Address - Street 1:2120 S COLLEGE AVE STE 8
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1465
Practice Address - Country:US
Practice Address - Phone:970-568-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty