Provider Demographics
NPI:1245738418
Name:DR. JOHN C BRENNAN PSYD, LP, PLC
Entity Type:Organization
Organization Name:DR. JOHN C BRENNAN PSYD, LP, PLC
Other - Org Name:DOWNRIVER HORIZON COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:248-470-6225
Mailing Address - Street 1:2955 BIDDLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5231
Mailing Address - Country:US
Mailing Address - Phone:249-698-8993
Mailing Address - Fax:734-324-1566
Practice Address - Street 1:2955 BIDDLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5231
Practice Address - Country:US
Practice Address - Phone:249-698-8993
Practice Address - Fax:734-324-1566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. JOHN C BRENNAN PSYD, LP, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty