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NPI Code Detail

MEDICARE: MISS MICHELLE M BRANTLEY

MEDICARE: MISS MICHELLE M BRANTLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor085742CA

General Provider Information

NPI Number : 1174725261
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MICHELLE M BRANTLEY
Provider Business Mailing Address
First Line : 14412 HOMEWARD ST
Second Line :
City : LA PUENTE
State : CA
Zip : 91744-2440
Country : US
Telephone Number : 626-918-3139
Fax Number :
Provider Business Practice Location Address
First Line : 558 N TOWNE AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-4826
Country : US
Telephone Number : 909-622-2273
Fax Number : 909-622-6334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2007
Last Update Date : 07/08/2007

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Directions to “ MISS MICHELLE M BRANTLEY ” Practice Location

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