Provider Demographics
NPI:1912506874
Name:BRAUE, LEAH CHAPMAN
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:CHAPMAN
Last Name:BRAUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:ELIZABETH
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3420 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-5122
Mailing Address - Country:US
Mailing Address - Phone:205-910-7554
Mailing Address - Fax:
Practice Address - Street 1:3420 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-5122
Practice Address - Country:US
Practice Address - Phone:205-910-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional