1568468627 NPI number — MRS. DANA C BRANSON LCSW, CASAC

Table of content: MRS. DANA C BRANSON LCSW, CASAC (NPI 1568468627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568468627 NPI number — MRS. DANA C BRANSON LCSW, CASAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANSON
Provider First Name:
DANA
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CASAC
Provider Gender Code:
F

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:
1568468627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 S SPRIGG ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE GIRARDEAU
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63703-6212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-651-4177
Provider Business Mailing Address Fax Number:
573-651-3636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 S SPRIGG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63703-6212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-651-4177
Provider Business Practice Location Address Fax Number:
573-651-3636
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  005663 , 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: 2111503 . This is a "FIRST HEALTH/COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 494750326 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431116734 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431116734 . This is a "EAP CERIDIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43111673463857A . This is a "TRI CARE WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 162909 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431116734 . This is a "EAP CONCERN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431116734 . This is a "NEW DIRECTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51130 . This is a "MOUNT CARMEL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11333199 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431116734 . This is a "EAP NEW DIRECTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431116734 . This is a "EAP WELLPOINT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431116734 . This is a "EAP INTERFACE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 713386 . This is a "HEALTHLINK PPO" identifier . This identifiers is of the category "OTHER".




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