Individual
BRANDY LEE BLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, TLLP
Contact information
Practice address
1655 E CARO RD, CARO, MI 48723-9319
(989) 673-2500
Mailing address
15030 TERRY RD, BERLIN, MI 48002-1213
(810) 434-4948
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016435
MI
Other
Enumeration date
09/10/2015
Last updated
08/17/2016
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