| Doctor Name: | BRANDON R BISE |
| NPI Number: | 1659735900 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 071006576 |
| Business Practice Address: | 440 Fox Town Rd Clintwood, VA - 242285077 |
| Business Phone Number: | 2769261680 |
| Business Fax Number: | 2769269179 |
| Mailing Address: | Po Box 309, CLINTWOOD |
| State: | VA |
| Postal Code: | 242280309 |
| Phone Number: | 2769261680 |
| Fax Number: | 2769269179 |
| NPI Enumeration Date: | 04/12/2016 |
| NPI Last Update Date: | 04/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 071006576 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |