MEDICARE: DENISE R BRAND 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	2689	SC

General Provider Information

NPI Number	:	1114065208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE R BRAND LPC

Provider Business Mailing Address
First Line	:	460 CHAMBERLIN RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-5428
Country	:	US
Telephone Number	:	843-655-1622
Fax Number	:	843-650-4890

Provider Business Practice Location Address
First Line	:	9403 HIGHWAY 707 STE C
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7758
Country	:	US
Telephone Number	:	843-655-1622
Fax Number	:	843-650-4890

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/13/2010

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