Brave Space Therapy Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

BRAVE SPACE THERAPY INC

Practice address

2220 Mountain Blvd Ste 240
Oakland, CA 94611-2905

Phone

(510) 500-5470

NPI assigned

Mar 7, 2023

Organization subpart

No

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

Authorized official

Name

Roni Khol, PSY.DNPI 1336773506

Title

Owner

Phone

(510) 500-5470

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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

• Roni Khol, PSYD

  • Clinical Psychologist
  • Oakland, CA
  • NPI 1336773506
  Medicare reassignment NPD Authorized official
• Akshay Naresh

  • Psychologist
  • Union City, CA
  • NPI 1992187496
  Medicare reassignment NPD

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

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757203200000",
    "number": "1346940491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 COLLEGE AVE STE 240E",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946181647",
            "telephone_number": "510-500-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 MOUNTAIN BLVD STE 240",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946112905",
            "telephone_number": "510-500-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVE SPACE THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-07",
        "last_updated": "2025-09-07",
        "certification_date": "2025-09-07",
        "status": "A",
        "authorized_official_last_name": "KHOL",
        "authorized_official_first_name": "RONI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-500-5470",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elena Brauchy, RN
• Aaron R Braun
• Bailey Braun
• Isabel P Braun, RN
• Jurgen Braungardt, PH.D.
• Carrie Bravo, P.T.
• Guillermina Bravo
• Moises Bravo Jr., MD
• Brandon Lowry Brawner, PSYCHOLOGIST
• Rodney Brazier

• Clinical Psychologist in Oakland, CA
• Providers in Oakland, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.