Provider Demographics
NPI:1639303191
Name:AVERETT, BRENDA Y (LPC,LSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:Y
Last Name:AVERETT
Suffix:
Gender:F
Credentials:LPC,LSW
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:Y
Other - Last Name:AVERETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC,LSW
Mailing Address - Street 1:302 N HURON ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2947
Mailing Address - Country:US
Mailing Address - Phone:734-834-7447
Mailing Address - Fax:734-483-6326
Practice Address - Street 1:302 NORTH HURON
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-834-7447
Practice Address - Fax:734-483-6326
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003040101YP2500X
MISC0000229101YS0200X
MI6802059684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker