Marissa Brandenburg, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401014770 Issued in MI

Practice address

3255 Pontaluna Rd
Fruitport, MI 49415

Phone

(231) 733-6720

NPI assigned

Jun 19, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hackley Community Care Center Inc

  • Federally Qualified Health Center (FQHC)
  • Fruitport, MI
  • NPI 1386298552
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641081600000",
    "number": "1114309796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 BAKER ST FL 3",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494442157",
            "telephone_number": "231-737-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 PONTALUNA RD",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "49415",
            "telephone_number": "231-733-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDENBURG",
        "first_name": "MARISSA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-19",
        "last_updated": "2022-01-02",
        "certification_date": "2022-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401014770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114309796",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marissabrandenburg@hccc.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Hackley Community Care direct email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3255 Pontaluna Rd",
            "city": "Fruitport",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Agape Home at Blueberry Fields Inc.
• Hannah Ellen Alveshere, DO
• Annette Book Bayne, L.M.S.W.
• Tammy Bonnier
• Sophia Spiros Bouyoucos-Sayen, RD
• Chase Burton
• Sameen Bashir Butt, M.D.
• CCR Home Health Care
• Jacob Charron, MD
• Chelsea Klipfel, D.D.S., P.L.L.C.

• Mental Health Counselor in Fruitport, MI
• Providers in Fruitport, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.