Provider Demographics
NPI:1730667262
Name:HARRISON, BRANDY LEIGH (LICSW)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEIGH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 N ARC ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-5011
Mailing Address - Country:US
Mailing Address - Phone:208-816-2950
Mailing Address - Fax:
Practice Address - Street 1:1923 N ARC ST
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-5011
Practice Address - Country:US
Practice Address - Phone:208-816-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607369031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60736903OtherLICENSE