Provider Demographics
NPI:1477329175
Name:ENGELEN, BRIAN MICHAEL (LPCC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:ENGELEN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 NORTHWESTERN AVE S
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7534
Mailing Address - Country:US
Mailing Address - Phone:651-789-4039
Mailing Address - Fax:651-439-4894
Practice Address - Street 1:1875 NORTHWESTERN AVE S
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7534
Practice Address - Country:US
Practice Address - Phone:651-789-4039
Practice Address - Fax:651-439-4894
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC04129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health