MEDICARE: BRITTANI DECESS MA, LLPC

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	6451019628

General Provider Information

NPI Number	:	1700551298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANI DECESS MA, LLPC

Provider Business Mailing Address
First Line	:	4764 FULTON ST E STE 204
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9086
Country	:	US
Telephone Number	:	616-200-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	4764 FULTON ST E STE 204
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9086
Country	:	US
Telephone Number	:	616-200-4433
Fax Number	:

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

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/16/2021

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