Healthcare Provider Details

I. General information

NPI: 1548578214
Provider Name (Legal Business Name): MELISSA ANNE BRABANDT M.A., LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E BIG BEAVER RD
TROY MI
48083-1905
US

IV. Provider business mailing address

4823 SUSSEX DR
SAN DIEGO CA
92116-2314
US

V. Phone/Fax

Practice location:
  • Phone: 248-524-8801
  • Fax: 248-524-8850
Mailing address:
  • Phone: 248-895-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011005
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401011005
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: