| Brave Space Psychotherapy | |
|
5665 College Ave Ste 240e Oakland CA 94618-1647 | |
| (510) 500-5470 | |
| Not Available |
| Full Name | Brave Space Psychotherapy |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 5665 College Ave Ste 240e, Oakland, California |
| Authorized Official Name and Position | Roni Khol (OWNER) |
| Authorized Official Contact | 5105005470 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brave Space Psychotherapy 5665 College Ave Ste 240e Oakland CA 94618-1647 Ph: (510) 500-5470 | Brave Space Psychotherapy 5665 College Ave Ste 240e Oakland CA 94618-1647 Ph: (510) 500-5470 |
| NPI Number | 1346940491 |
|---|---|
| Provider Enumeration Date | 03/07/2023 |
| Last Update Date | 10/19/2024 |
| Certification Date | 10/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346940491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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