Individual
MARISSA BRANDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3255 PONTALUNA RD, FRUITPORT, MI 49415
(231) 733-6720
Mailing address
2700 BAKER ST FL 3, MUSKEGON, MI 49444-2157
(231) 737-1335
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401014770
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114309796
—
MI
Enumeration date
06/19/2015
Last updated
01/02/2022
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