Individual provider · NPI-1

Pheynell Branch, AAS, CSAC,CSIT

Counselor, Addiction (Substance Use Disorder) · Racine, WI

NPI number1457780496
StatusActive
Last updated in NPPESNov 8, 2013

Details

NPI
1457780496
Entity type
Individual (NPI-1)
Name
Mrs. Pheynell Branch
Credential
AAS, CSAC,CSIT
Sex
Female
Sole proprietor
No
Enumeration date
Nov 8, 2013
Last updated
Nov 8, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YA0400X Counselor, Addiction (Substance Use Disorder)15662-132WIYes
101YA0400X Counselor, Addiction (Substance Use Disorder)15476-133WI

Practice location

1650 Wasington Ave
Racine, WI 53403

Phone 262-633-5001

Mailing address

6737 W Washington St Ste 2210
West Allis, WI 53214-5650

Phone 414-777-1570

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