Basic Information
| Provider Information | |||||||||
| NPI: | 1548578214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRABANDT | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | M.A., LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4823 SUSSEX DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921162314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488957570 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1225 E BIG BEAVER RD | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485248801 | ||||||||
| FaxNumber: | 2485248850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2010 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401011005 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | 6401011005 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.