Provider Demographics
NPI:1659735900
Name:BISE, BRANDON R (LPC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:R
Last Name:BISE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-0309
Mailing Address - Country:US
Mailing Address - Phone:276-926-1680
Mailing Address - Fax:276-926-9179
Practice Address - Street 1:440 FOX TOWN RD
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-5077
Practice Address - Country:US
Practice Address - Phone:276-926-1680
Practice Address - Fax:276-926-9179
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA071006576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional