Provider Demographics
NPI:1952194748
Name:BRAVELY MINDED LLC
Entity type:Organization
Organization Name:BRAVELY MINDED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:PIRAPORN
Authorized Official - Middle Name:
Authorized Official - Last Name:SATJAYAKORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-831-7405
Mailing Address - Street 1:12104 GARDEN GROVE CIR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-9021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12104 GARDEN GROVE CIR UNIT 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-9021
Practice Address - Country:US
Practice Address - Phone:703-831-7405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty