Provider Demographics
NPI:1265935779
Name:HEENAN, BRENDA EMILY (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:EMILY
Last Name:HEENAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:
Other - Last Name:HEENAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLPC
Mailing Address - Street 1:1386 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48819-9696
Mailing Address - Country:US
Mailing Address - Phone:517-331-3142
Mailing Address - Fax:
Practice Address - Street 1:311 HARRISON ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-1577
Practice Address - Country:US
Practice Address - Phone:517-338-3090
Practice Address - Fax:517-338-3090
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional