Provider Demographics
NPI:1134315401
Name:MARKERT-GREEN, BRENDA-JOYCE G (DMFT)
Entity Type:Individual
Prefix:DR
First Name:BRENDA-JOYCE
Middle Name:G
Last Name:MARKERT-GREEN
Suffix:
Gender:F
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-0024
Mailing Address - Country:US
Mailing Address - Phone:909-503-7191
Mailing Address - Fax:
Practice Address - Street 1:5775 NIMTZ PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-6194
Practice Address - Country:US
Practice Address - Phone:909-503-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48104101YP1600X, 101Y00000X, 101YP2500X, 103G00000X, 106H00000X
MI4101006620106H00000X
IN35001876A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist