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General NPI Number Information
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NPI Number | 1003277674
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Entity Type | Individual
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Provider Name | BRENDEN ARIAS TUDOR LLPC, AT
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Gender | Male
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 1611 OAK AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-2468
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Country | US
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Telephone | 231-767-1921
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 OAK AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-2468
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Country | US
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Telephone | 231-767-1921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001963
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401018626
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License Number State | MI
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