| Bravo Mind Psychiatry Pllc | |
|
4405 7th Ave Se Ste 200 Lacey WA 98503-1055 | |
| (210) 201-2656 | |
| Not Available |
| Full Name | Bravo Mind Psychiatry Pllc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 4405 7th Ave Se Ste 200, Lacey, Washington |
| Authorized Official Name and Position | Johanna Villasenor Nardini (MANAGING MEMBER) |
| Authorized Official Contact | 2102012656 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bravo Mind Psychiatry Pllc 13423 Blanco Rd Unit 3164 San Antonio TX 78216-2187 Ph: (210) 201-2656 | Bravo Mind Psychiatry Pllc 4405 7th Ave Se Ste 200 Lacey WA 98503-1055 Ph: (210) 201-2656 |
| NPI Number | 1982440400 |
|---|---|
| Provider Enumeration Date | 07/03/2024 |
| Last Update Date | 01/17/2025 |
| Certification Date | 01/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982440400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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