Provider Demographics
NPI:1356712970
Name:CONEY, BRETT ALLEN (MA, LLP)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:ALLEN
Last Name:CONEY
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10047 BIG HAND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MI
Mailing Address - Zip Code:48063-2801
Mailing Address - Country:US
Mailing Address - Phone:517-643-3531
Mailing Address - Fax:
Practice Address - Street 1:10047 BIG HAND RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MI
Practice Address - Zip Code:48063-2801
Practice Address - Country:US
Practice Address - Phone:517-643-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010901103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist