Provider Demographics
NPI:1093568909
Name:WHISENANT, BRANDY LEA (LPCA)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:LEA
Last Name:WHISENANT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LEON ST
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-3409
Mailing Address - Country:US
Mailing Address - Phone:409-291-1314
Mailing Address - Fax:
Practice Address - Street 1:960 LEON ST
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-3409
Practice Address - Country:US
Practice Address - Phone:409-291-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1214492101YS0200X
TX94680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool