| Brave Changes, Llc | |
|
7250 S Ballpark Dr Apt 106 Franklin WI 53132-7026 | |
| (414) 666-4211 | |
| Not Available |
| Full Name | Brave Changes, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7250 S Ballpark Dr Apt 106, Franklin, Wisconsin |
| Authorized Official Name and Position | Lori-ana Guillen (LCSW) |
| Authorized Official Contact | 4146664211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brave Changes, Llc 7250 S Ballpark Dr Apt 106 Franklin WI 53132-7026 Ph: (414) 666-4211 | Brave Changes, Llc 7250 S Ballpark Dr Apt 106 Franklin WI 53132-7026 Ph: (414) 666-4211 |
| NPI Number | 1972339935 |
|---|---|
| Provider Enumeration Date | 09/09/2024 |
| Last Update Date | 09/09/2024 |
| Certification Date | 09/09/2024 |
| Medicare PECOS PAC ID | 3274074935 |
|---|---|
| Medicare Enrollment ID | O20240920002320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972339935 | NPI | - | NPPES |
| Provider Name | Lori-ana Elisa Guillen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366127714 PECOS PAC ID: 4183165848 Enrollment ID: I20241007001680 |
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