| Brookside Services, Pllc | |
|
55 E Iroquois Rd Pontiac MI 48341-2016 | |
| (248) 390-5919 | |
| Not Available |
| Full Name | Brookside Services, Pllc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 55 E Iroquois Rd, Pontiac, Michigan |
| Authorized Official Name and Position | Brenda Joyce Washington (PRESIDENT) |
| Authorized Official Contact | 2483905919 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brookside Services, Pllc Po Box 430355 Pontiac MI 48343-0355 Ph: (248) 390-5919 | Brookside Services, Pllc 55 E Iroquois Rd Pontiac MI 48341-2016 Ph: (248) 390-5919 |
| NPI Number | 1013056563 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013056563 | NPI | - | NPPES |
| $$$$$$$$$ | Other | MI | SSN OF SOLE PROPRIETOR |
| 6801073653 | Other | MI | STATE CLINICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 6801073653 (Michigan) | Primary |
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