MEDICARE: ISRAEL ALEJANDRO BRITO LPC, TLLP

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	6401018340	MI

General Provider Information

NPI Number	:	1265960660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISRAEL ALEJANDRO BRITO LPC, TLLP

Provider Business Mailing Address
First Line	:	1345 MONROE AVE NW STE 209
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4663
Country	:	US
Telephone Number	:	616-414-4197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 MONROE AVE NW STE 209
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4663
Country	:	US
Telephone Number	:	616-414-4197
Fax Number	:

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

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	07/10/2023

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