Healthcare Provider Details

I. General information

NPI: 1164844551
Provider Name (Legal Business Name): SHANALEE J BRANHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 MAIN ST
SOUTH SHORE KY
41175-9558
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 866-233-1955
  • Fax: 606-783-9952
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number166702
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: