Provider Demographics
NPI:1649856626
Name:THE BRAVE ONES THERAPY CENTER
Entity type:Organization
Organization Name:THE BRAVE ONES THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CIERRA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:COLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:407-745-4616
Mailing Address - Street 1:4314 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-2135
Mailing Address - Country:US
Mailing Address - Phone:407-745-4616
Mailing Address - Fax:
Practice Address - Street 1:4314 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2135
Practice Address - Country:US
Practice Address - Phone:407-745-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health