MEDICARE: WILLIAM A BRANDNER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401007921	MI

General Provider Information

NPI Number	:	1013252683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM A BRANDNER LPC

Provider Business Mailing Address
First Line	:	2640 TIMPSON AVE SE
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-9519
Country	:	US
Telephone Number	:	616-260-0992
Fax Number	:

Provider Business Practice Location Address
First Line	:	4467 CASCADE RD SE
Second Line	:	SUITE 4481
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3776
Country	:	US
Telephone Number	:	616-260-0992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	12/07/2012

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