Organization
BRAVE SPACE THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONI KHOL PSY.D (OWNER)
(510) 500-5470
Entity
Organization
Contact information
Practice address
2220 MOUNTAIN BLVD STE 240, OAKLAND, CA 94611-2905
(510) 500-5470
Mailing address
5665 COLLEGE AVE STE 240E, OAKLAND, CA 94618-1647
(510) 500-5470
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
03/07/2023
Last updated
09/07/2025
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