Provider Demographics
NPI:1336424233
Name:CHILDRESS, BRANDY LYNN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LYNN
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1384
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-1384
Mailing Address - Country:US
Mailing Address - Phone:701-818-4967
Mailing Address - Fax:833-502-4632
Practice Address - Street 1:405 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746-7425
Practice Address - Country:US
Practice Address - Phone:701-818-4967
Practice Address - Fax:833-502-4632
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-941101Y00000X
ND986-1-1-19-A101YP2500X
ND986-1-1-19101YP2500X
ND986-1-1-19-423101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional