Healthcare Provider Details

I. General information

NPI: 1386378784
Provider Name (Legal Business Name): ALYSSA ANN BREMNER BRADFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 AUBURN RD STE 208
AUBURN HILLS MI
48326-4001
US

IV. Provider business mailing address

705 BARCLAY CIR STE 125
ROCHESTER HILLS MI
48307-4575
US

V. Phone/Fax

Practice location:
  • Phone: 248-289-1894
  • Fax:
Mailing address:
  • Phone: 248-983-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: