Provider Demographics
NPI:1598794653
Name:LINCOLN, BRETT D (EDD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:D
Last Name:LINCOLN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-1569
Mailing Address - Country:US
Mailing Address - Phone:269-823-4328
Mailing Address - Fax:
Practice Address - Street 1:724 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-1569
Practice Address - Country:US
Practice Address - Phone:269-823-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301004033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical