Provider Demographics
NPI:1669511978
Name:RENDEL, BRIAN D (MA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:RENDEL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SHELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1835
Mailing Address - Country:US
Mailing Address - Phone:906-482-9077
Mailing Address - Fax:906-482-2502
Practice Address - Street 1:609 SHELDEN AVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1835
Practice Address - Country:US
Practice Address - Phone:906-482-9077
Practice Address - Fax:906-482-2502
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008918103T00000X
MI6401003795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist