Provider Demographics
NPI:1003240169
Name:LEGG BRAVERLLY, DENISE O (LIMHP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:O
Last Name:LEGG BRAVERLLY
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:O
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP
Mailing Address - Street 1:11414 W CENTER RD STE 314
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4420
Mailing Address - Country:US
Mailing Address - Phone:402-639-2901
Mailing Address - Fax:
Practice Address - Street 1:11414 W CENTER RD STE 314
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4420
Practice Address - Country:US
Practice Address - Phone:402-960-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4474101YM0800X
101YP2500X
NE2178101YP2500X
NE1377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health