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General NPI Number Information
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NPI Number | 1760004907
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Entity Type | Individual
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Provider Name | BRANDON ROBERT PETER MIELKE MA, LPC, NCC, CAADC
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Gender | Male
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 410 E LAKE ST STE 100
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City | PETOSKEY
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State | MI
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Zip | 49770-2437
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Country | US
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Telephone | 231-622-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 3670 N LYNN ST
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City | ONAWAY
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State | MI
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Zip | 49765-8914
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Country | US
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Telephone | 586-337-5800
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401223756
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License Number State | MI
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