Provider Demographics
NPI:1457956146
Name:LABA, BRIAN KIERAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KIERAN
Last Name:LABA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1506
Mailing Address - Country:US
Mailing Address - Phone:734-994-3201
Mailing Address - Fax:
Practice Address - Street 1:3830 PACKARD ST STE 160
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2357
Practice Address - Country:US
Practice Address - Phone:734-929-9703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional