Provider Demographics
NPI:1760004907
Name:MIELKE, BRANDON ROBERT PETER (MA, LPC, NCC, CAADC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ROBERT PETER
Last Name:MIELKE
Suffix:
Gender:M
Credentials:MA, LPC, NCC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 N LYNN ST
Mailing Address - Street 2:
Mailing Address - City:ONAWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49765-8914
Mailing Address - Country:US
Mailing Address - Phone:586-337-5800
Mailing Address - Fax:
Practice Address - Street 1:410 E LAKE ST STE 100
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2437
Practice Address - Country:US
Practice Address - Phone:231-622-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional