Healthcare Provider Details

I. General information

NPI: 1932017019
Provider Name (Legal Business Name): MOLLY BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 100TH ST SE
BYRON CENTER MI
49315-8766
US

IV. Provider business mailing address

4543 GRANGE RD
MIDDLEVILLE MI
49333-9513
US

V. Phone/Fax

Practice location:
  • Phone: 616-210-9751
  • Fax:
Mailing address:
  • Phone: 517-599-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: