Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301009495 | MI |
NPI | 1013363803 |
---|---|
Provider Name | Susan Brenner |
First Address | Spring Lake, MI 49456-1957 |
Second Address | Spring Lake, MI 49456-1957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2016 |
Last Update Date | 08/06/2016 |