Provider Demographics
NPI:1457796765
Name:GARLICH, BRANDI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:
Last Name:GARLICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:CUMMINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 OAK DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5635
Mailing Address - Country:US
Mailing Address - Phone:217-549-5889
Mailing Address - Fax:
Practice Address - Street 1:3 OAK DR STE B
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5635
Practice Address - Country:US
Practice Address - Phone:217-549-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0174571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid