Provider Demographics
NPI:1215447123
Name:THIEL, BRIAN JAMES (MSW, LLMSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:THIEL
Suffix:
Gender:M
Credentials:MSW, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 W FAIRVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4139
Mailing Address - Country:US
Mailing Address - Phone:586-610-7487
Mailing Address - Fax:
Practice Address - Street 1:1311 W FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-4139
Practice Address - Country:US
Practice Address - Phone:586-610-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
MI68511149721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No175T00000XOther Service ProvidersPeer Specialist