MEDICARE: TWO BRAVE VIKINGS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM2800X	Methadone Clinic

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	EMC0001010	OTHER	MI	MICHIGAN MEDICAL LICENSE
2	5315227009	OTHER	MI	MICHIGAN CONTROLLED SUBSTANCE

General Provider Information

NPI Number	:	1780568352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWO BRAVE VIKINGS LLC

Provider Business Mailing Address
First Line	:	PO BOX 15
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48804-0015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 N MISSION ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-1825
Country	:	US
Telephone Number	:	989-294-2138
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MINDI WOODRUFF
Credential	:
Telephone Number	:	480-826-2771

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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Directions to “TWO BRAVE VIKINGS LLC ” Practice Location

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