Healthcare Provider Details

I. General information

NPI: 1184395972
Provider Name (Legal Business Name): BRENDEN BELL LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 BELLE CHASE WAY
LANSING MI
48911-4252
US

IV. Provider business mailing address

5635 STORROW CT
WARREN MI
48092-6338
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851111265
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: