MEDICARE: MS. HEATHER BRAINERD 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	6401014814	MI

General Provider Information

NPI Number	:	1962958769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER BRAINERD LLPC

Provider Business Mailing Address
First Line	:	812 E JOLLY RD STE 210
Second Line	:	ATTN DIANA SMITH
City	:	LANSING
State	:	MI
Zip	:	48910-6821
Country	:	US
Telephone Number	:	517-346-8119
Fax Number	:	517-346-8291

Provider Business Practice Location Address
First Line	:	812 E JOLLY RD
Second Line	:	STE 216
City	:	LANSING
State	:	MI
Zip	:	48910-6821
Country	:	US
Telephone Number	:	517-346-8200
Fax Number	:	517-346-8291

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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