1407868110 NPI number — MRS. BRENDA K MICHAEL LPC

Table of content: MRS. BRENDA K MICHAEL LPC (NPI 1407868110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407868110 NPI number — MRS. BRENDA K MICHAEL LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAEL
Provider First Name:
BRENDA
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407868110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISONBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22803-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-564-5636
Provider Business Mailing Address Fax Number:
540-433-4123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
644 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISONBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22801-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-564-5629
Provider Business Practice Location Address Fax Number:
540-433-4338
Provider Enumeration Date:
08/12/2006

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: 101YP2500X , with the licence number:  0701000830 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 084552M . This is a "SENTARA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1164637518 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11426850 . This is a "CAQH PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 177051 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2240808 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 432609 . This is a "VALUE OPTIONS PROVIDER NO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010069593 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251026 . This is a "COMPSYCH PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C05754 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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