MARISSA BRANDENBURG LPC NPI 1114309796

NPI Information

  • NPI: 1114309796
  • Provider Name: MARISSA BRANDENBURG, LPC
  • Classification: Counselor - 101YM0800X
  • Specialization: Mental Health
  • Entity Type: Individual
  • Address: 3255 PONTALUNA RD
    FRUITPORT, MI
    ZIP 49415
  • Phone: (231) 733-6720

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NPI Details

Marissa Brandenburg, LPC is a mental health counselor in Fruitport, MI. Marissa Brandenburg, LPC NPI is 1114309796. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3255 PONTALUNA RD
FRUITPORT, MI
ZIP 49415
Phone: (231) 733-6720

The enumeration date for this NPI number is 6/19/2015 and was last updated on 1/2/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental Health6401014770MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11114309796MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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