Provider Demographics
NPI:1356836498
Name:BRATTON, CHUCK ALLEN I (BSW)
Entity Type:Individual
Prefix:
First Name:CHUCK
Middle Name:ALLEN
Last Name:BRATTON
Suffix:I
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 KIRTS BLVD STE 231
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4156
Mailing Address - Country:US
Mailing Address - Phone:248-269-1307
Mailing Address - Fax:
Practice Address - Street 1:570 KIRTS BLVD STE 231
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4156
Practice Address - Country:US
Practice Address - Phone:248-269-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802077913104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker