Provider Demographics
NPI:1184512907
Name:BRAVE ABA
Entity type:Organization
Organization Name:BRAVE ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HALIMO
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-319-1718
Mailing Address - Street 1:4470 W 78TH STREET CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4470 W 78TH STREET CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5408
Practice Address - Country:US
Practice Address - Phone:507-319-1718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health