Provider Demographics
NPI:1841474269
Name:BRANN, MARY HEATHER (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HEATHER
Last Name:BRANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22711 E 29TH STREET LANE CT S
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-7319
Mailing Address - Country:US
Mailing Address - Phone:816-220-0204
Mailing Address - Fax:
Practice Address - Street 1:3101 TROOST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-1845
Practice Address - Country:US
Practice Address - Phone:816-931-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070041361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical