Healthcare Provider Details

I. General information

NPI: 1790452456
Provider Name (Legal Business Name): BRAVE SPACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 SHELBY ST STE 201
INDIANAPOLIS IN
46203-1167
US

IV. Provider business mailing address

735 SHELBY ST STE 201
INDIANAPOLIS IN
46203-1167
US

V. Phone/Fax

Practice location:
  • Phone: 317-740-1001
  • Fax: 317-792-8169
Mailing address:
  • Phone: 317-740-1001
  • Fax: 317-792-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EMILY M KIRSCHBAUM
Title or Position: OWNER & THERAPIST
Credential: LCSW
Phone: 317-740-1001