Provider Demographics
NPI:1730693060
Name:MACROBIOTIC ED COUNSELING & PSYCHO
Entity type:Organization
Organization Name:MACROBIOTIC ED COUNSELING & PSYCHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:AYER
Authorized Official - Last Name:BREIDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MALLP, LPC
Authorized Official - Phone:586-944-8741
Mailing Address - Street 1:164 KINGSBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6603
Mailing Address - Country:US
Mailing Address - Phone:586-944-8741
Mailing Address - Fax:586-944-2234
Practice Address - Street 1:164 KINGSBROOK AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6603
Practice Address - Country:US
Practice Address - Phone:586-944-8741
Practice Address - Fax:586-944-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty