MEDICARE: BRAVE-HEART THERAPY AND COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497522296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAVE-HEART THERAPY AND COUNSELING

Provider Business Mailing Address
First Line	:	315 CHERRY WOOD
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-6629
Country	:	US
Telephone Number	:	541-951-8168
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 CHERRY WOOD
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-6629
Country	:	US
Telephone Number	:	541-325-8446
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN OLSON
Credential	:	LCSW
Telephone Number	:	541-951-8168

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	03/02/2026

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