Healthcare Provider Details

I. General information

NPI: 1134661390
Provider Name (Legal Business Name): JEREMIAH BRANUM M. ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 AVE C
BILLINGS MT
59102
US

IV. Provider business mailing address

1074 AVE C
BILLINGS MT
59102
US

V. Phone/Fax

Practice location:
  • Phone: 406-563-8117
  • Fax: 406-563-5956
Mailing address:
  • Phone: 406-563-8117
  • Fax: 406-563-5956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: