Provider Demographics
NPI:1962900217
Name:BRINK, MICHELLE LYNN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:BRINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3264
Mailing Address - Country:US
Mailing Address - Phone:724-465-2311
Mailing Address - Fax:724-465-2339
Practice Address - Street 1:163 PLAZA RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3264
Practice Address - Country:US
Practice Address - Phone:724-465-2311
Practice Address - Fax:724-465-2339
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health