Provider Demographics
NPI:1841862307
Name:BRINKMAN, MARCUS BLAKE
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:BLAKE
Last Name:BRINKMAN
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 1:1215 29TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7793
Mailing Address - Country:US
Mailing Address - Phone:503-360-5591
Mailing Address - Fax:
Practice Address - Street 1:1811 GREENVIEW PL SW STE 103
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4354
Practice Address - Country:US
Practice Address - Phone:507-536-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health