Provider Demographics
NPI:1811329287
Name:BRADY, HEATHER L (MSMHC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:BRADY
Suffix:
Gender:F
Credentials:MSMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 N FIVE MILE RD
Mailing Address - Street 2:TRLR 33
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5389
Mailing Address - Country:US
Mailing Address - Phone:208-559-7824
Mailing Address - Fax:
Practice Address - Street 1:8620 W EMERALD ST
Practice Address - Street 2:STE 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4824
Practice Address - Country:US
Practice Address - Phone:208-672-2900
Practice Address - Fax:208-672-2919
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)