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NPI Profile for MARISSA BRANDENBURG in FRUITPORT CHARTER TOWNSHIP, MI.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health |
101YM0800X |
| NPI # | 1114309796 |
|
| Status | Active | |
| Credentials | LPC (Licensed Professional Counselor) | |
| Entity | Individual | |
| Enumeration date | 06/19/2015 | |
| Last updated | 01/02/2022 - About 4 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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MARISSA BRANDENBURG
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MARISSA BRANDENBURG, LPC