NPIMap

Organization Active NPI

Brave Spaces Counseling and Wellness, LLC

  • Community/Behavioral Health Agency
  • La Crosse, WI
National Provider Identifier
1811580574
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BRAVE SPACES COUNSELING AND WELLNESS, LLC
Practice address
605 4TH St S
La Crosse, WI 54601-4458
Phone
(608) 386-5495
NPI assigned
Feb 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Nicole Milliren, M.SNPI 1679740963
Title
Owner
Phone
(608) 386-5495

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

605 4TH St S
La Crosse, WI 54601-4458

Mailing address

605 4TH St S
La Crosse, WI 54601-4458
Phone (608) 386-5495

Other identifiers 3

IdentifierTypeStateIssuer
1033777800MedicaidWI
100007945MedicaidWI
100031418MedicaidWI

Other names 1

  • Infinity Training & Consulting Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.Brave-spaces.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221010002255 WI Part B Supplier - Clinic/Group Practice 8921484247 Receives reassigned benefits from 1 practitioner
Practice locations: La Crosse, WI

National Provider Directory

National Provider Directory

Locations

605 4th St S
La Crosse, WI 54601
Phone (608) 386-5495

121 W Franklin St
Sparta, WI 54656
Phone (608) 386-4160

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1613260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1811580574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 4TH ST S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546014458",
            "telephone_number": "608-386-5495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 4TH ST S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546014458",
            "telephone_number": "608-386-5495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVE SPACES COUNSELING AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-14",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "MILLIREN",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-386-5495",
        "authorized_official_credential": "M.S"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033777800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100007945",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100031418",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.Brave-spaces.org",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Holmen",
            "address_1": "605 4th St S",
            "city": "LA Crosse",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546014458",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Infinity Training & Consulting",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in La Crosse, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.