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General NPI Number Information
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NPI Number | 1447704911
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Entity Type | Individual
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Provider Name | GRACE LYNE BROTHERTON LIMHP, LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 520 N 7TH ST
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0709
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Country | US
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Telephone | 402-320-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 37053 HUTCHINGS AVE
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City | HASTINGS
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State | IA
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Zip | 51540-4067
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Country | US
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Telephone | 712-621-7300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10973
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1971
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 082103
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License Number State | IA
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