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NPI Code Detail

MEDICARE: THE BRAVE SPACE LLC

MEDICARE: THE BRAVE SPACE 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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1467398560
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE BRAVE SPACE LLC
Provider Business Mailing Address
First Line : 101 E MILWAUKEE ST STE 600
Second Line :
City : JANESVILLE
State : WI
Zip : 53545-3004
Country : US
Telephone Number : 608-974-6017
Fax Number : 855-840-4797
Provider Business Practice Location Address
First Line : 101 E MILWAUKEE ST STE 600
Second Line :
City : JANESVILLE
State : WI
Zip : 53545-3004
Country : US
Telephone Number : 608-974-6017
Fax Number : 855-840-4797
Authorized Official
Title or Position : OWNER
Name : MARY KATE COLLEEN MASKE
Credential : LPC
Telephone Number : 608-974-6017
Provider Enumeration Date : 04/28/2026
Last Update Date : 04/28/2026

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Directions to “THE BRAVE SPACE LLC ” Practice Location

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