Provider Demographics
NPI:1588310544
Name:BRENNEMAN, MICHELLE LEE (MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 WILLAGILLESPIE RD STE 22
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6723
Mailing Address - Country:US
Mailing Address - Phone:541-972-3095
Mailing Address - Fax:
Practice Address - Street 1:1142 WILLAGILLESPIE RD STE 22
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6723
Practice Address - Country:US
Practice Address - Phone:541-972-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8886101YM0800X
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health