Provider Demographics
NPI:1932574225
Name:LEOS, BRANDI (SUDCCII)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:LEOS
Suffix:
Gender:F
Credentials:SUDCCII
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 26622
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6622
Mailing Address - Country:US
Mailing Address - Phone:559-352-0860
Mailing Address - Fax:559-272-6431
Practice Address - Street 1:3043 W ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2160
Practice Address - Country:US
Practice Address - Phone:559-352-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
225400000X
CA8308101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)