Provider Demographics
NPI:1548557804
Name:JANISCH, BRANDI (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:JANISCH
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:KAY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:600 SPRING HILL RING RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-7300
Mailing Address - Country:US
Mailing Address - Phone:773-682-8518
Mailing Address - Fax:
Practice Address - Street 1:600 SPRING HILL RING RD
Practice Address - Street 2:SUITE 118
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-7300
Practice Address - Country:US
Practice Address - Phone:773-682-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional