Provider Demographics
NPI:1346411147
Name:BRANT, DAVID W (LPC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:BRANT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 LEESPORT AVE
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-9528
Mailing Address - Country:US
Mailing Address - Phone:610-334-4724
Mailing Address - Fax:
Practice Address - Street 1:770 LEESPORT AVE
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-9528
Practice Address - Country:US
Practice Address - Phone:610-334-4724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional