Provider Demographics
NPI:1851895783
Name:MICHAEL BRUBAKER COUNSELING
Entity Type:Organization
Organization Name:MICHAEL BRUBAKER COUNSELING
Other - Org Name:MICHAEL BRUBAKER COUNSELING, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:BRUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC/NCGC II
Authorized Official - Phone:520-836-9788
Mailing Address - Street 1:1927 N. TREKELL RD, STE. D
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122
Mailing Address - Country:US
Mailing Address - Phone:520-836-9788
Mailing Address - Fax:520-421-1975
Practice Address - Street 1:1927 N. TREKELL RD
Practice Address - Street 2:STE D
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122
Practice Address - Country:US
Practice Address - Phone:520-836-9788
Practice Address - Fax:520-421-1975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL BRUBAKER COUNSELING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISACAZ0122251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health