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NPI Code Detail

MEDICARE: BRYAN NIXON COUNSELING, LLC

MEDICARE: BRYAN NIXON COUNSELING, LLC
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 Counselor6401012317MI

General Provider Information

NPI Number : 1780021733
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRYAN NIXON COUNSELING, LLC
Provider Business Mailing Address
First Line : 985 PARCHMENT DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-3659
Country : US
Telephone Number : 616-425-2412
Fax Number :
Provider Business Practice Location Address
First Line : 985 PARCHMENT DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-3659
Country : US
Telephone Number : 616-425-2412
Fax Number :
Authorized Official
Title or Position : OWNER/COUNSELOR PROFESSIONAL
Name : BRYAN J NIXON
Credential : LPC
Telephone Number : 616-881-1464
Provider Enumeration Date : 05/31/2013
Last Update Date : 06/20/2022

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