Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 39000901A | IN |
N | 101YP1600X | Pastoral Counselor | MEMBER NO.6830 | IN |
NPI | 1033194865 |
---|---|
Provider Name | Ms. Margarete Elizabeth Brandenburg |
First Address | Logansport, IN 46947-2744 |
Second Address | Logansport, IN 46947-2744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000362553 | ANTHEM BC/BS (01) | IN |
11477753 | CAQH (01) | IN |