Healthcare Provider Details

I. General information

NPI: 1649544073
Provider Name (Legal Business Name): BRENDA LYN EASTERLING MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W 8TH ST
MIO MI
48647-9140
US

IV. Provider business mailing address

1110 W 8TH ST
MIO MI
48647-9140
US

V. Phone/Fax

Practice location:
  • Phone: 989-826-2400
  • Fax:
Mailing address:
  • Phone: 989-826-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number6401012398
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401012398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: