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General NPI Number Information
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NPI Number | 1750939864
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Entity Type | Organization
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Legal Business Name | BRAVE, LLC
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Dates
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Enumeration Date | 09/01/2019
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 2100 FORUM BLVD STE C-2
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City | COLUMBIA
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State | MO
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Zip | 65203-5436
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Country | US
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Telephone | 573-862-6992
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Fax |
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Provider Business Mailing Address
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Address Line | 203 JOHNSON CT
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City | ASHLAND
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State | MO
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Zip | 65010-9473
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Country | US
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Telephone | 573-862-6992
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH HOCKER
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Credential | LPC
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Telephone | 573-823-6992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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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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