Provider Demographics
NPI:1922322734
Name:DUNHAM, BRENDA JANE (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JANE
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E BROADWAY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2701
Mailing Address - Country:US
Mailing Address - Phone:989-772-5833
Mailing Address - Fax:989-772-5901
Practice Address - Street 1:600 E BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2701
Practice Address - Country:US
Practice Address - Phone:989-772-5833
Practice Address - Fax:989-772-5901
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional