| Brave Choices, Inc. | |
|
1619 Dayton Ave Ste 112b Saint Paul MN 55104-6276 | |
| (612) 889-7517 | |
| (651) 389-0550 |
| Full Name | Brave Choices, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 1619 Dayton Ave Ste 112b, Saint Paul, Minnesota |
| Authorized Official Name and Position | Heather Marie Holt (MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 6128897517 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brave Choices, Inc. 1575 7th St W Ste 104 Saint Paul MN 55102-4252 Ph: (612) 889-7517 | Brave Choices, Inc. 1619 Dayton Ave Ste 112b Saint Paul MN 55104-6276 Ph: (612) 889-7517 |
| NPI Number | 1740637750 |
|---|---|
| Provider Enumeration Date | 05/19/2016 |
| Last Update Date | 09/19/2021 |
| Certification Date | 09/19/2021 |
| Medicare PECOS PAC ID | 3072857622 |
|---|---|
| Medicare Enrollment ID | O20181207001840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740637750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 21742 (Minnesota) | Primary |
| Provider Name | Heather M Holt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043608706 PECOS PAC ID: 2769703867 Enrollment ID: I20150601002674 |
| Provider Name | Elizabeth L Silkey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649569757 PECOS PAC ID: 5395181655 Enrollment ID: I20240308000771 |
| Provider Name | Gail J Grogan Pedersen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952046294 PECOS PAC ID: 5092157131 Enrollment ID: I20240521003694 |
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