Provider Demographics
NPI:1801205786
Name:BRANTLEY, LANETTA (LPC-CR)
Entity Type:Individual
Prefix:
First Name:LANETTA
Middle Name:
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:LPC-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 E ENTERPRISE PKWY
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2351
Mailing Address - Country:US
Mailing Address - Phone:330-840-2516
Mailing Address - Fax:
Practice Address - Street 1:2451 E ENTERPRISE PKWY
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2351
Practice Address - Country:US
Practice Address - Phone:330-840-2516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300072-CR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health