=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740945690
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE LEE MARIE BRITO M.S. LLPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2021
-----------------------------------------------------
Last Update Date | 11/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2520 PACKARD RD RM 7
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 737-480-8099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9861 TIOGA TRL
-----------------------------------------------------
City | PINCKNEY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48169-8159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-410-5816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6451020899
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------