Provider Demographics
NPI:1083080857
Name:BRIM, KOASTER (MSW,LMSW)
Entity Type:Individual
Prefix:MS
First Name:KOASTER
Middle Name:
Last Name:BRIM
Suffix:
Gender:F
Credentials:MSW,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S LINDEN RD
Mailing Address - Street 2:P.O.BOX 320115
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-9998
Mailing Address - Country:US
Mailing Address - Phone:810-655-3867
Mailing Address - Fax:
Practice Address - Street 1:2500 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-7074
Practice Address - Country:US
Practice Address - Phone:810-655-3867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011060711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13189Medicaid
MI3833CMedicaid