Provider Demographics
NPI:1447327655
Name:EHLE, BRANDON C (PSYD LLP)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:C
Last Name:EHLE
Suffix:
Gender:M
Credentials:PSYD LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 NORTHLAND DRIVE SUITE A
Mailing Address - Street 2:NORTH KENT GUIDANCE SERVICES LLC
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1040
Mailing Address - Country:US
Mailing Address - Phone:616-361-5001
Mailing Address - Fax:616-631-2166
Practice Address - Street 1:5250 NORTHLAND DRIVE SUITE A
Practice Address - Street 2:NORTH KENT GUIDANCE SERVICES LLC
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1040
Practice Address - Country:US
Practice Address - Phone:616-361-5001
Practice Address - Fax:616-631-2166
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist