Provider Demographics
NPI:1447704911
Name:BROTHERTON, GRACE LYNE (LIMHP, LMHC)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:LYNE
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:LIMHP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37053 HUTCHINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:IA
Mailing Address - Zip Code:51540-4067
Mailing Address - Country:US
Mailing Address - Phone:712-621-7300
Mailing Address - Fax:
Practice Address - Street 1:520 N 7TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0709
Practice Address - Country:US
Practice Address - Phone:402-320-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10973101YP2500X
NE1971101YP2500X
IA082103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional