Provider Demographics
NPI:1316665649
Name:BRAND NUBIANS MENTAL HEALTH COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:BRAND NUBIANS MENTAL HEALTH COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:616-375-0138
Mailing Address - Street 1:1334 BENJAMIN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3229
Mailing Address - Country:US
Mailing Address - Phone:616-375-0138
Mailing Address - Fax:
Practice Address - Street 1:1334 BENJAMIN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3229
Practice Address - Country:US
Practice Address - Phone:616-375-0138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty