Provider Demographics
NPI:1912886508
Name:BRAVE ROOTS COUNSELING CENTER LLC
Entity type:Organization
Organization Name:BRAVE ROOTS COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUARING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:971-645-5937
Mailing Address - Street 1:51579 COLUMBIA RIVER HWY STE I
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-8411
Mailing Address - Country:US
Mailing Address - Phone:971-380-0238
Mailing Address - Fax:833-559-0967
Practice Address - Street 1:51579 COLUMBIA RIVER HWY STE I
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-8411
Practice Address - Country:US
Practice Address - Phone:971-380-0238
Practice Address - Fax:833-559-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty