Provider Demographics
NPI:1225225527
Name:BROTHERSON, LEANNA T (MA)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:T
Last Name:BROTHERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:T
Other - Last Name:OLIVIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2409 HOMER CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2207
Mailing Address - Country:US
Mailing Address - Phone:256-582-4240
Mailing Address - Fax:256-582-4161
Practice Address - Street 1:2409 HOMER CLAYTON DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2207
Practice Address - Country:US
Practice Address - Phone:256-582-4240
Practice Address - Fax:256-582-4161
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51543704OtherBCBS