Provider Demographics
NPI:1659828770
Name:BROWNFIELD, MICAELLA
Entity Type:Individual
Prefix:
First Name:MICAELLA
Middle Name:
Last Name:BROWNFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 GRATIOT RD # 307
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5987
Mailing Address - Country:US
Mailing Address - Phone:989-475-4600
Mailing Address - Fax:
Practice Address - Street 1:6235 GRATIOT RD # 307
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5987
Practice Address - Country:US
Practice Address - Phone:989-475-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015627101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional