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General NPI Number Information
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NPI Number | 1033939061
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Entity Type | Individual
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Provider Name | KYLIE BROWN-PENNINGTON
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 3300 WASHTENAW AVE STE 282
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City | ANN ARBOR
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State | MI
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Zip | 48104-5184
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Country | US
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Telephone | 734-743-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 23381 PORTAGE WAY APT 2006
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City | NOVI
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State | MI
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Zip | 48375-3296
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Country | US
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Telephone | 734-678-3455
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6851118297
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License Number State | MI
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