Organization
BRAVE SPACES COUNSELING AND WELLNESS, LLC
Active
Other names
Infinity Training & Consulting
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE MILLIREN M.S (OWNER)
(608) 386-5495
Entity
Organization
Contact information
Practice address
605 4TH ST S, LA CROSSE, WI 54601-4458
(608) 386-5495
Mailing address
605 4TH ST S, LA CROSSE, WI 54601-4458
(608) 386-5495
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100007945
—
WI
05
—
100031418
—
WI
05
—
1033777800
—
WI
Enumeration date
02/14/2021
Last updated
08/15/2022
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