Provider Demographics
NPI:1255079133
Name:BRAVE PATH COUNSELING PLLC
Entity type:Organization
Organization Name:BRAVE PATH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:A'NNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JURICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CRADC
Authorized Official - Phone:618-218-3394
Mailing Address - Street 1:1325 E MAIN ST # 1020
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8474 MARTIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822-2354
Practice Address - Country:US
Practice Address - Phone:618-218-3394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty