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General NPI Number Information
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NPI Number | 1396412375
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Entity Type | Organization
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Legal Business Name | BRAVE HEARTS MARRIAGE AND FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 1404 E 1ST ST APT 10
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City | LONG BEACH
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State | CA
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Zip | 90802-8209
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Country | US
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Telephone | 323-471-3822
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 E 1ST ST APT 10
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City | LONG BEACH
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State | CA
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Zip | 90802-8209
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Country | US
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Telephone | 323-471-3822
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CAROLINE OLSEN-VAN STONE
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Credential | LMFT
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Telephone | 323-471-3822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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