Provider Demographics
NPI:1316644347
Name:FREED BRAVO, BERNICE (MA)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:FREED BRAVO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-0531
Mailing Address - Country:US
Mailing Address - Phone:971-533-3814
Mailing Address - Fax:
Practice Address - Street 1:390 NW GROPPER RD
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-6254
Practice Address - Country:US
Practice Address - Phone:509-427-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty