Provider Demographics
NPI:1063396810
Name:WHALEY, BRIANA LEIGH-GROSE (RMHCI, MA, MS, MDIV,)
Entity type:Individual
Prefix:MRS
First Name:BRIANA
Middle Name:LEIGH-GROSE
Last Name:WHALEY
Suffix:
Gender:F
Credentials:RMHCI, MA, MS, MDIV,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NEW HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3221
Mailing Address - Country:US
Mailing Address - Phone:727-424-8417
Mailing Address - Fax:
Practice Address - Street 1:1250 W EAU GALLIE BLVD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5385
Practice Address - Country:US
Practice Address - Phone:727-424-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH28016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health