Provider Demographics
NPI:1609187855
Name:BRANDOW, SHELLEY M (LPC)
Entity Type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:M
Last Name:BRANDOW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:MB
Other - Last Name:WIEGAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1029 N 3RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3509
Mailing Address - Country:US
Mailing Address - Phone:906-226-7410
Mailing Address - Fax:
Practice Address - Street 1:1029 N 3RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3509
Practice Address - Country:US
Practice Address - Phone:906-226-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006918101YM0800X
MI6802080124104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker