Provider Demographics
NPI:1003022914
Name:BRITTON, THERESA LOUISE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LOUISE
Last Name:BRITTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 GREENSPIRE DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-8040
Mailing Address - Country:US
Mailing Address - Phone:810-240-7776
Mailing Address - Fax:
Practice Address - Street 1:777 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-5065
Practice Address - Country:US
Practice Address - Phone:269-369-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801078975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health