| Bravura Therapy Pllc | |
|
561 W Diversey Pkwy Ste 209 Chicago IL 60614-1682 | |
| (872) 222-8044 | |
| Not Available |
| Full Name | Bravura Therapy Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 561 W Diversey Pkwy Ste 209, Chicago, Illinois |
| Authorized Official Name and Position | Aubrey Ryan (CO-OWNER) |
| Authorized Official Contact | 8722228044 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bravura Therapy Pllc 561 W Diversey Pkwy Ste 209 Chicago IL 60614-1682 Ph: (872) 222-8044 | Bravura Therapy Pllc 561 W Diversey Pkwy Ste 209 Chicago IL 60614-1682 Ph: (872) 222-8044 |
| NPI Number | 1255951158 |
|---|---|
| Provider Enumeration Date | 04/21/2020 |
| Last Update Date | 03/13/2024 |
| Certification Date | 03/13/2024 |
| Medicare PECOS PAC ID | 5193161578 |
|---|---|
| Medicare Enrollment ID | O20240307002108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255951158 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Aubrey Ryan |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1396080297 PECOS PAC ID: 7911343306 Enrollment ID: I20240314002119 |
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