MEDICARE: BRAVE IS BETTER LLC

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1245895960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAVE IS BETTER LLC

Provider Business Mailing Address
First Line	:	226 S MORRISON AVE
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-2711
Country	:	US
Telephone Number	:	618-514-4842
Fax Number	:	618-514-4842

Provider Business Practice Location Address
First Line	:	226 S MORRISON AVE
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-2711
Country	:	US
Telephone Number	:	618-514-4842
Fax Number	:	618-514-4842

Authorized Official
Title or Position	:	CEO/PSYCHOTHERAPIST
Name	:	CHRISTINE BALLANCE
Credential	:	LCPC
Telephone Number	:	618-593-5866

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	05/08/2019

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