Provider Demographics
NPI:1760739924
Name:MARSHALL, BRETT R (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:R
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1015
Mailing Address - Country:US
Mailing Address - Phone:407-792-0900
Mailing Address - Fax:
Practice Address - Street 1:1414 LEXINGTON GREEN LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1015
Practice Address - Country:US
Practice Address - Phone:407-792-0900
Practice Address - Fax:407-369-8659
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health