Provider Demographics
NPI:1730365602
Name:BRUMMELL-PRESLEY, OSLIN (MSW, CAAC, CPS)
Entity type:Individual
Prefix:MRS
First Name:OSLIN
Middle Name:
Last Name:BRUMMELL-PRESLEY
Suffix:
Gender:F
Credentials:MSW, CAAC, CPS
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:BRUMMELL-PRESLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, CAAC, CPS
Mailing Address - Street 1:1226 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2634
Mailing Address - Country:US
Mailing Address - Phone:989-754-3743
Mailing Address - Fax:
Practice Address - Street 1:1226 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2634
Practice Address - Country:US
Practice Address - Phone:989-754-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00577101YA0400X
MI6801081269101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10Medicaid