Active NPI
Theresa A. Bruner-Leydens, LPC
- Professional Counselor
- Kenosha, WI
National Provider Identifier
1447581715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3187-125
- Practice address
- 4039 80TH St
Suite D
Kenosha, WI 53142-4959 - Phone
- (262) 657-5026
- Fax
- (262) 657-5663
- NPI assigned
- Jan 26, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3187-125 | WI | Primary |
Addresses
Primary practice location
4039 80TH St
Suite D
Kenosha, WI 53142-4959
Mailing address
4039 80TH St
Suite D
Kenosha, WI 53142-4959
Phone (262) 657-5026
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3187-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264464000000",
"number": "1447581715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4039 80TH ST",
"address_2": "SUITE D",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531424959",
"telephone_number": "262-657-5026",
"fax_number": "262-657-5663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4039 80TH ST",
"address_2": "SUITE D",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531424959",
"telephone_number": "262-657-5026",
"fax_number": "262-657-5663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNER-LEYDENS",
"first_name": "THERESA",
"middle_name": "A.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-01-26",
"last_updated": "2010-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "3187-125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.