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NPI Code Detail

MEDICARE: BRYAN BRANDENBURG MS, LPC

MEDICARE: BRYAN BRANDENBURG MS, 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
1101YP2500XProfessional Counselor102717AK

General Provider Information

NPI Number : 1508411075
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN BRANDENBURG MS, LPC
Provider Business Mailing Address
First Line : 1630 N RIVER ROCK CIR
Second Line :
City : PALMER
State : AK
Zip : 99645-9698
Country : US
Telephone Number : 907-441-7392
Fax Number :
Provider Business Practice Location Address
First Line : 26731 W POINT MACKENZIE RD
Second Line :
City : WASILLA
State : AK
Zip : 99623-8709
Country : US
Telephone Number : 907-376-4534
Fax Number : 907-376-3248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2019
Last Update Date : 01/10/2022

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Directions to “ BRYAN BRANDENBURG MS, LPC” Practice Location

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