Provider Demographics
NPI:1992147144
Name:BROWN, BRANDY TESSA (MA, LAMFT)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:TESSA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NIAGARA LN N STE 201
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4911
Mailing Address - Country:US
Mailing Address - Phone:612-213-6775
Mailing Address - Fax:
Practice Address - Street 1:1700 NIAGARA LN N STE 201
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4911
Practice Address - Country:US
Practice Address - Phone:612-213-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2722106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist