NPIMap

Organization Active NPI

Brave Grand Rapids LLC

  • Professional Counselor
  • Grand Rapids, MI
National Provider Identifier
1285086900
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401015446 Issued in MI
Legal business name
BRAVE GRAND RAPIDS LLC
Practice address
103 College Ave SE
Grand Rapids, MI 49503-5921
Phone
(616) 419-8628
NPI assigned
Jul 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Allison Kyle Waldron, LLPCNPI 1902258510
Title
Manager
Phone
(616) 419-8628

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 6401015446 MI Primary

Addresses

Primary practice location

103 College Ave SE
Grand Rapids, MI 49503-5921

Mailing address

103 College Ave SE
Grand Rapids, MI 49503-5921
Phone (616) 419-8628

Other names 1

  • Brave GR Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1285086900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 COLLEGE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035921",
            "telephone_number": "616-419-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 COLLEGE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035921",
            "telephone_number": "616-419-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVE GRAND RAPIDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "WALDRON",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "616-419-8628",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LLPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401015446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brave GR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.