1295254704 NPI number — MARIANNE B. BRANHAM, LCSW, LLC

Table of content: (NPI 1295254704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295254704 NPI number — MARIANNE B. BRANHAM, LCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIANNE B. BRANHAM, LCSW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295254704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2716 FORUM BLVD STE 4B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65203-5450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-817-9611
Provider Business Mailing Address Fax Number:
573-817-9610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2716 FORUM BLVD.
Provider Second Line Business Practice Location Address:
SUITE 4B
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-817-9611
Provider Business Practice Location Address Fax Number:
573-817-9610
Provider Enumeration Date:
09/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BRANHAM
Authorized Official First Name:
MARIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
573-817-9611

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW005043 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10849131 . This is a "CAQH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1124105622 . This is a "NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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