Provider Demographics
NPI:1467119362
Name:BRANNAN, ALEXIS MARY (LLMSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARY
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5862 GRAND OAKS DR NE
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8581
Mailing Address - Country:US
Mailing Address - Phone:773-666-3082
Mailing Address - Fax:
Practice Address - Street 1:5862 GRAND OAKS DR NE
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8581
Practice Address - Country:US
Practice Address - Phone:773-666-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851109232104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker