MEDICARE: KATIE BRAVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8450	SC

General Provider Information

NPI Number	:	1215416870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE BRAVE

Provider Business Mailing Address
First Line	:	108 PALMETTO PARK BLVD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-7968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 HARDEN ST STE B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1800
Country	:	US
Telephone Number	:	803-748-7002
Fax Number	:	803-252-5259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	02/09/2026

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Directions to “ KATIE BRAVE ” Practice Location

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