Provider Demographics
NPI:1821833450
Name:BRAVE LIFE COUNSELING PLLC
Entity type:Organization
Organization Name:BRAVE LIFE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:LAMBETH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-242-9021
Mailing Address - Street 1:46289 LAKE MARY RONAN RD
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59929-9705
Mailing Address - Country:US
Mailing Address - Phone:309-242-9021
Mailing Address - Fax:
Practice Address - Street 1:7235 US HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:MT
Practice Address - Zip Code:59922-9812
Practice Address - Country:US
Practice Address - Phone:309-242-9021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional