Provider Demographics
NPI:1134369382
Name:MINTON, BRANDON (MS, LLPC)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:MINTON
Suffix:
Gender:M
Credentials:MS, LLPC
Other - Prefix:MR
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:MINTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LLPC
Mailing Address - Street 1:18261 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20651 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2622
Practice Address - Country:US
Practice Address - Phone:313-271-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-01
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional