Provider Demographics
NPI:1447581715
Name:BRUNER-LEYDENS, THERESA A (LPC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:BRUNER-LEYDENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 80TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4959
Mailing Address - Country:US
Mailing Address - Phone:262-657-5026
Mailing Address - Fax:262-657-5663
Practice Address - Street 1:4039 80TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4959
Practice Address - Country:US
Practice Address - Phone:262-657-5026
Practice Address - Fax:262-657-5663
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3187-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional