Provider Demographics
NPI:1689230211
Name:GEORGE-COPELAND, BRANDY
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:GEORGE-COPELAND
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 1:702 N BLACKHAWK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3357
Mailing Address - Country:US
Mailing Address - Phone:608-286-2393
Mailing Address - Fax:608-231-2334
Practice Address - Street 1:702 N BLACKHAWK AVE STE 104
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3357
Practice Address - Country:US
Practice Address - Phone:608-286-2393
Practice Address - Fax:608-231-2334
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1369-124106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist