Provider Demographics
NPI:1568015782
Name:BRADY, MOLLIE MARY ROSE (LPCC)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:MARY ROSE
Last Name:BRADY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 OLSON MEM HWY, STE 202
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:507-474-6264
Mailing Address - Fax:507-218-8553
Practice Address - Street 1:4800 OLSON MEM HWY, STE 202
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:507-474-6264
Practice Address - Fax:507-218-8553
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02164101YP2500X
MNLP7012103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional