Provider Demographics
NPI:1205965225
Name:FELDMAN, BRIAN CHARLES (MA, LPC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHARLES
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W HURON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-456-1991
Mailing Address - Fax:248-456-8151
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:STE 100
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-456-1991
Practice Address - Fax:248-456-8151
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid