Provider Demographics
NPI:1386288546
Name:BRANDT BADGER LLC
Entity type:Organization
Organization Name:BRANDT BADGER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:BRANDT
Authorized Official - Last Name:BADGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHCA
Authorized Official - Phone:812-345-9919
Mailing Address - Street 1:408 E DODDS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4819
Mailing Address - Country:US
Mailing Address - Phone:812-345-9919
Mailing Address - Fax:812-610-1482
Practice Address - Street 1:205 N COLLEGE AVE STE 613
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3956
Practice Address - Country:US
Practice Address - Phone:812-200-6122
Practice Address - Fax:812-610-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)