Provider Demographics
NPI:1720438062
Name:BRANDSMA, MICHELLE C (MS, CADC III,MAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:BRANDSMA
Suffix:
Gender:F
Credentials:MS, CADC III,MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 NE ELK ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-8381
Mailing Address - Country:US
Mailing Address - Phone:225-699-8343
Mailing Address - Fax:
Practice Address - Street 1:2051 NE ELK ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-8381
Practice Address - Country:US
Practice Address - Phone:225-699-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-QMHPC-001132101YM0800X
OR15-09-24101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health