Provider Demographics
NPI:1013252683
Name:BRANDNER, WILLIAM A (LPC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:BRANDNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 TIMPSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-9519
Mailing Address - Country:US
Mailing Address - Phone:616-260-0992
Mailing Address - Fax:
Practice Address - Street 1:4467 CASCADE RD SE
Practice Address - Street 2:SUITE 4481
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3776
Practice Address - Country:US
Practice Address - Phone:616-260-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional