Individual
MRS. BRENDA L TICKNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LIMHP, LMHC, SADC, L
Contact information
Practice address
427 E. KANESVILLE BLVD., SUITE 308, COUNCIL BLUFFS, IA 51503-4499
(402) 616-9876
(712) 355-5120
Mailing address
2412 S. 11TH STREET, COUNCIL BLUFFS, IA 51501-7407
(402) 616-9876
(712) 355-5120
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2098
NE
101YA0400X
Addiction (Substance Use Disorder) Counselor
814
NE
101YM0800X
Mental Health Counselor
Primary
1543
NE
101YM0800X
Mental Health Counselor
4316
NE
101YM0800X
Mental Health Counselor
9295
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
814
LADC
NE
01
—
9295
PLMHP
NE
Enumeration date
05/08/2008
Last updated
09/06/2019
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