Provider Demographics
NPI:1568057271
Name:LEEPER, BRIAN SCOTT JR (CHC, CLC, NLP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:SCOTT
Last Name:LEEPER
Suffix:JR
Gender:M
Credentials:CHC, CLC, NLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 N BYRKIT ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-7119
Mailing Address - Country:US
Mailing Address - Phone:574-205-9410
Mailing Address - Fax:
Practice Address - Street 1:1518 N BYRKIT ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-7119
Practice Address - Country:US
Practice Address - Phone:574-205-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist