Provider Demographics
NPI:1568022259
Name:MASON, BRANDY (LLPC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:MISS
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:PORTERFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLPC
Mailing Address - Street 1:21196 WOODFARM DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9765
Mailing Address - Country:US
Mailing Address - Phone:248-679-6952
Mailing Address - Fax:833-233-2242
Practice Address - Street 1:21196 WOODFARM DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-9765
Practice Address - Country:US
Practice Address - Phone:248-679-6952
Practice Address - Fax:833-233-2242
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451017268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health