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NPI Code Detail

MEDICARE: MELISSA ANNE BRABANDT M.A., LPC, NCC

MEDICARE: MELISSA ANNE BRABANDT M.A., LPC, NCC
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 Counselor6401011005MI
2101Y00000XCounselor6401011005MI

General Provider Information

NPI Number : 1548578214
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA ANNE BRABANDT M.A., LPC, NCC
Provider Business Mailing Address
First Line : 4823 SUSSEX DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-2314
Country : US
Telephone Number : 248-895-7570
Fax Number :
Provider Business Practice Location Address
First Line : 1225 E BIG BEAVER RD
Second Line :
City : TROY
State : MI
Zip : 48083-1905
Country : US
Telephone Number : 248-524-8801
Fax Number : 248-524-8850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2010
Last Update Date : 03/26/2020

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