Provider Demographics
NPI:1811291818
Name:WUMMEL, BRIAN DANIEL (MA, LLPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DANIEL
Last Name:WUMMEL
Suffix:
Gender:M
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 HALL RD STE 303
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5726
Mailing Address - Country:US
Mailing Address - Phone:586-997-4956
Mailing Address - Fax:
Practice Address - Street 1:11111 HALL RD STE 303
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5726
Practice Address - Country:US
Practice Address - Phone:586-997-4956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid