Healthcare Provider Details

I. General information

NPI: 1285009712
Provider Name (Legal Business Name): HELEN T BRANTLEY PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CONNER DR SUITE #204
CHAPEL HILL NC
27514-7039
US

IV. Provider business mailing address

109 CONNER DR SUITE #204
CHAPEL HILL NC
27514-7039
US

V. Phone/Fax

Practice location:
  • Phone: 919-933-0273
  • Fax: 919-240-5922
Mailing address:
  • Phone: 919-933-0273
  • Fax: 919-240-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0560
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0560
License Number StateNC

VIII. Authorized Official

Name: JOHN BRANTLEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-316-9286