Provider Demographics
NPI:1578850491
Name:SCHMIDT, BRANDON (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34556 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3225
Mailing Address - Country:US
Mailing Address - Phone:248-579-0856
Mailing Address - Fax:248-786-5324
Practice Address - Street 1:50430 SCHOOL HOUSE RD STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5910
Practice Address - Country:US
Practice Address - Phone:248-579-0856
Practice Address - Fax:248-786-5324
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional