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General NPI Number Information
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NPI Number | 1609187855
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Entity Type | Individual
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Provider Name | SHELLEY M BRANDOW LPC
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 1029 N 3RD ST SUITE B
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City | MARQUETTE
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State | MI
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Zip | 49855-3509
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Country | US
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Telephone | 906-226-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 N 3RD ST SUITE B
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City | MARQUETTE
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State | MI
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Zip | 49855-3509
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Country | US
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Telephone | 906-226-7410
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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 | 6401006918
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802080124
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License Number State | MI
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