Provider Demographics
NPI:1457716409
Name:BRAVE, MELODY (LCSW)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:BRAVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 14136
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65814-0136
Mailing Address - Country:US
Mailing Address - Phone:510-633-3356
Mailing Address - Fax:
Practice Address - Street 1:4140 S FAIRVIEW AVE STE 104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4857
Practice Address - Country:US
Practice Address - Phone:417-234-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150286381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical