Basic Information
| Provider Information | |||||||||
| NPI: | 1982655239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEPISTO | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HURLEY PLZ | ||||||||
| Address2: | SUITE 300 PFS WEST CAMPUS | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102622320 | ||||||||
| FaxNumber: | 8102391281 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 HURLEY PLZ | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102629682 | ||||||||
| FaxNumber: | 8102767245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 04/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301003056 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.