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General NPI Number Information
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NPI Number | 1700785136
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Entity Type | Organization
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Legal Business Name | BRAVE HORIZON INSTITUTE LLC
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 4104 KIMBERLY CT
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City | HIGH RIDGE
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State | MO
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Zip | 63049-2867
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Country | US
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Telephone | 636-275-0574
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Fax |
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Provider Business Mailing Address
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Address Line | 4104 KIMBERLY CT
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City | HIGH RIDGE
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State | MO
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Zip | 63049-2867
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Country | US
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Telephone | 636-275-0574
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDI GILLAM
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Credential | LPC
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Telephone | 636-275-0574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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