Healthcare Provider Details

I. General information

NPI: 1831488261
Provider Name (Legal Business Name): LEANNA J BRADY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 CLARK ST
DES MOINES IA
50314-1964
US

IV. Provider business mailing address

1409 CLARK ST
DES MOINES IA
50314-1964
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-6517
  • Fax: 515-643-6598
Mailing address:
  • Phone: 515-643-6517
  • Fax: 515-643-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number002274
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00730
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: