Provider Demographics
NPI:1558741892
Name:BROOKMYER, GARRETT (MA)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:BROOKMYER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 MOORSBRIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4422
Mailing Address - Country:US
Mailing Address - Phone:269-371-3700
Mailing Address - Fax:
Practice Address - Street 1:8080 MOORSBRIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4422
Practice Address - Country:US
Practice Address - Phone:269-371-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional