Provider Demographics
NPI:1871834341
Name:BRANDON A COUSSENS LMFT LLC
Entity Type:Organization
Organization Name:BRANDON A COUSSENS LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:COUSSENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:478-335-4743
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817-0022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:654 MAIN ST
Practice Address - Street 2:STE 6
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-7403
Practice Address - Country:US
Practice Address - Phone:706-595-2548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001247251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health