Healthcare Provider Details

I. General information

NPI: 1437099280
Provider Name (Legal Business Name): BRIAN NATHANIEL LITTLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7587 DUNROSS DR
PORTAGE MI
49024-7882
US

IV. Provider business mailing address

7587 DUNROSS DR
PORTAGE MI
49024-7882
US

V. Phone/Fax

Practice location:
  • Phone: 269-270-8412
  • Fax:
Mailing address:
  • Phone: 269-270-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023706
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: