Provider Demographics
NPI:1821202656
Name:BRENTON, GAIL A (LMSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:A
Last Name:BRENTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BACON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1666
Mailing Address - Country:US
Mailing Address - Phone:517-898-9919
Mailing Address - Fax:
Practice Address - Street 1:101 E BACON ST STE 201
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1666
Practice Address - Country:US
Practice Address - Phone:517-898-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health