Provider Demographics
NPI:1902653041
Name:BRAVELY BUILDING THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:BRAVELY BUILDING THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUBB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:810-986-1780
Mailing Address - Street 1:1048 DUQUESA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:MI
Mailing Address - Zip Code:48893-9392
Mailing Address - Country:US
Mailing Address - Phone:810-986-1780
Mailing Address - Fax:
Practice Address - Street 1:1048 DUQUESA DR
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:MI
Practice Address - Zip Code:48893-9392
Practice Address - Country:US
Practice Address - Phone:810-986-1780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty