Provider Demographics
NPI:1184180747
Name:JOURNEY BRAVELY
Entity type:Organization
Organization Name:JOURNEY BRAVELY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHENIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:918-237-9874
Mailing Address - Street 1:301 WAYNE TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5043
Mailing Address - Country:US
Mailing Address - Phone:918-237-9874
Mailing Address - Fax:
Practice Address - Street 1:301 WAYNE TRL
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5043
Practice Address - Country:US
Practice Address - Phone:918-237-9874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty