Provider Demographics
NPI:1689344459
Name:BRANDLI, MICHAEL JUDE (LCMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUDE
Last Name:BRANDLI
Suffix:
Gender:M
Credentials:LCMHC
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 338
Mailing Address - Street 2:
Mailing Address - City:WELLS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05081-0338
Mailing Address - Country:US
Mailing Address - Phone:802-757-2325
Mailing Address - Fax:802-757-3215
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05081-3000
Practice Address - Country:US
Practice Address - Phone:802-757-2325
Practice Address - Fax:802-757-3215
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health