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General NPI Number Information
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NPI Number | 1427927409
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Entity Type | Organization
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Legal Business Name | BRAVE LITTLE HOOVES LICENSED PROFESSIONAL CLINICAL COUNSELOR
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 11925 BLAKE RD
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City | WILTON
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State | CA
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Zip | 95693-8537
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Country | US
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Telephone | 209-730-6425
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 401
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City | WILTON
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State | CA
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Zip | 95693-0401
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Country | US
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Telephone | 209-730-6425
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CARMEN CARL
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Credential |
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Telephone | 209-730-6425
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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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