MEDICARE: BRANDENBURG4LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1467304451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDENBURG4LLC

Provider Business Mailing Address
First Line	:	1870 BOONESBOROUGH RD
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-9323
Country	:	US
Telephone Number	:	859-358-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 BOONESBOROUGH RD
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-9323
Country	:	US
Telephone Number	:	859-358-2051
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	REBECCA BRANDENBURG
Credential	:	MSN, FNP, PMHNP-BC
Telephone Number	:	859-358-2051

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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