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General NPI Number Information
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NPI Number | 1891233490
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Entity Type | Individual
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Provider Name | BRANDON MAXWELL M.A.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 62226 COUNTY ROAD 15
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City | GOSHEN
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State | IN
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Zip | 46526-9438
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Country | US
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Telephone | 574-875-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 22436 BREAKWATER DR APT 3A
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City | ELKHART
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State | IN
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Zip | 46516-8998
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Country | US
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Telephone | 570-702-1772
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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 |
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License Number State |
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