Healthcare Provider Details

I. General information

NPI: 1114408770
Provider Name (Legal Business Name): BRAVING DOULA COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10699 W 9TH PL
LAKEWOOD CO
80215-5621
US

IV. Provider business mailing address

10699 W 9TH PL
LAKEWOOD CO
80215-5621
US

V. Phone/Fax

Practice location:
  • Phone: 720-435-4522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MR. MAC BRYDUM
Title or Position: OWNER
Credential: MSW, CD/CBE (DTI)
Phone: 720-435-4522