Healthcare Provider Details

I. General information

NPI: 1013252683
Provider Name (Legal Business Name): WILLIAM A BRANDNER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 CASCADE RD SE SUITE 4481
GRAND RAPIDS MI
49546-3776
US

IV. Provider business mailing address

2640 TIMPSON AVE SE
LOWELL MI
49331-9519
US

V. Phone/Fax

Practice location:
  • Phone: 616-260-0992
  • Fax:
Mailing address:
  • Phone: 616-260-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007921
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: