Provider Demographics
NPI:1649055781
Name:BRAVE TRANSFORMATIONS THERAPY
Entity type:Organization
Organization Name:BRAVE TRANSFORMATIONS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-808-2622
Mailing Address - Street 1:642 KIT CARSON CIR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3428
Mailing Address - Country:US
Mailing Address - Phone:801-808-2622
Mailing Address - Fax:
Practice Address - Street 1:642 KIT CARSON CIR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-3428
Practice Address - Country:US
Practice Address - Phone:801-808-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty