Provider Demographics
NPI:1770656118
Name:BRAKKE, LEANN MARIE (LPC, MS, NBCC)
Entity Type:Individual
Prefix:MS
First Name:LEANN
Middle Name:MARIE
Last Name:BRAKKE
Suffix:
Gender:F
Credentials:LPC, MS, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2426
Mailing Address - Country:US
Mailing Address - Phone:205-979-0699
Mailing Address - Fax:205-979-0699
Practice Address - Street 1:1025 MONTGOMERY HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2805
Practice Address - Country:US
Practice Address - Phone:205-979-0699
Practice Address - Fax:205-979-0699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional