Individual
MR. BRANDON MICHAEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2499
(217) 528-7541
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
178.020431
IL
101YP2500X
Professional Counselor
Primary
178020431
IL
Other
Enumeration date
10/02/2024
Last updated
12/19/2024
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