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General NPI Number Information
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NPI Number | 1851002679
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Entity Type | Organization
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Legal Business Name | BRAVEMIND COUNSELING, LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 110 PLEASANT STREET
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City | COLFAX
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State | CA
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Zip | 95713
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Country | US
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Telephone | 530-401-2245
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1598
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City | COLFAX
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State | CA
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Zip | 95713-1598
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Country | US
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Telephone | 530-401-2245
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | NICOLE LESCHER
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Credential | LCSW
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Telephone | 530-401-2245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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