Provider Demographics
NPI:1730688292
Name:BURNHAM, BRANDY (MA, LLP, LPC, NCC)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:MA, LLP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 RAMBLING RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1630
Mailing Address - Country:US
Mailing Address - Phone:269-345-0909
Mailing Address - Fax:
Practice Address - Street 1:2019 RAMBLING RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1630
Practice Address - Country:US
Practice Address - Phone:269-345-0909
Practice Address - Fax:269-345-4985
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018204101Y00000X
MI6301017311103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor