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General NPI Number Information
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NPI Number | 1730871823
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Entity Type | Individual
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Provider Name | TRESSA BREWER
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Gender | Female
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 48578 PONTIAC TRL
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City | WIXOM
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State | MI
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Zip | 48393-2554
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Country | US
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Telephone | 248-669-5263
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Fax |
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Provider Business Mailing Address
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Address Line | 16560 CHESTNUT ST
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City | ROSEVILLE
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State | MI
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Zip | 48066-4312
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Country | US
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Telephone | 586-252-8763
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851118391
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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