Provider Demographics
NPI:1205612967
Name:THE BRAVE LIFE THERAPY
Entity type:Organization
Organization Name:THE BRAVE LIFE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:603-860-2584
Mailing Address - Street 1:9135 N MERIDIAN ST STE C5
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1817
Mailing Address - Country:US
Mailing Address - Phone:317-533-0329
Mailing Address - Fax:
Practice Address - Street 1:9135 N MERIDIAN ST STE C5
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1817
Practice Address - Country:US
Practice Address - Phone:317-533-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)