Healthcare Provider Details

I. General information

NPI: 1700705316
Provider Name (Legal Business Name): BRAIN BRIDGES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W LAKE LANSING RD
EAST LANSING MI
48823-8661
US

IV. Provider business mailing address

3003 E MICHIGAN AVE # 1095
LANSING MI
48912-4616
US

V. Phone/Fax

Practice location:
  • Phone: 941-315-9290
  • Fax:
Mailing address:
  • Phone: 941-315-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN KOENIG
Title or Position: LICENSED MASTER SOCIAL WORKER
Credential: LMSW
Phone: 941-315-9290