Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801095707 | MI |
NPI | 1003238007 |
---|---|
Provider Name | Brooke Champt |
First Address | Traverse City, MI 49686-4344 |
Second Address | Cadillac, MI 49601-2540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2014 |
Last Update Date | 09/01/2014 |