1972560357 NPI number — DEBRA SUE BRINKLOW LMSW

Table of content: DEBRA SUE BRINKLOW LMSW (NPI 1972560357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972560357 NPI number — DEBRA SUE BRINKLOW LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINKLOW
Provider First Name:
DEBRA
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TEADT
Provider Other First Name:
DEBRA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972560357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 N. MAIN ST.
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
CHELSEA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-645-5684
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48118-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-645-5684
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6801032927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)