Provider Demographics
NPI:1851410278
Name:LEBARON, BRIAN KEITH (LCPC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:LEBARON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 247
Mailing Address - Street 2:413 PRIMROSE LANE
Mailing Address - City:DAVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61019-9121
Mailing Address - Country:US
Mailing Address - Phone:815-865-5389
Mailing Address - Fax:815-865-5611
Practice Address - Street 1:20 E MILWAUKEE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3069
Practice Address - Country:US
Practice Address - Phone:608-755-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3767-125101YP2500X
IL178004166101YP2500X
IL180.006898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional