Provider Demographics
NPI:1316180011
Name:BRANT, BRENDA DIANE (PSYD, EDS, LP)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:DIANE
Last Name:BRANT
Suffix:
Gender:F
Credentials:PSYD, EDS, LP
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:DIANE
Other - Last Name:HENEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18473 97TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1368
Mailing Address - Country:US
Mailing Address - Phone:763-416-9310
Mailing Address - Fax:
Practice Address - Street 1:18473 97TH PL N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-1368
Practice Address - Country:US
Practice Address - Phone:763-416-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4320103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent