Provider Demographics
NPI:1033194865
Name:BRANDENBURG, MARGARETE ELIZABETH (LMHC, MDIV, MA)
Entity Type:Individual
Prefix:MS
First Name:MARGARETE
Middle Name:ELIZABETH
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:LMHC, MDIV, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 NORTH ST
Mailing Address - Street 2:STE 2A
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-2744
Mailing Address - Country:US
Mailing Address - Phone:574-727-0819
Mailing Address - Fax:
Practice Address - Street 1:417 NORTH ST
Practice Address - Street 2:STE 2A
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2744
Practice Address - Country:US
Practice Address - Phone:574-727-0819
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000901A101YM0800X
INMEMBER NO.6830101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000362553OtherANTHEM BC/BS
IN11477753OtherCAQH