Healthcare Provider Details

I. General information

NPI: 1609959212
Provider Name (Legal Business Name): BRANCHES OF LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 POPLAR AVE STE 5
MEMPHIS TN
38104-7278
US

IV. Provider business mailing address

PO BOX 40632
MEMPHIS TN
38174-0632
US

V. Phone/Fax

Practice location:
  • Phone: 901-728-5554
  • Fax: 901-728-6011
Mailing address:
  • Phone: 901-728-5554
  • Fax: 901-728-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAC23491
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberF16765
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number308
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBC23491
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC908
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberF20063
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW3185
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW1502
License Number StateAR
# 10
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLPC908
License Number StateTN
# 11
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberMD010748
License Number StateTN
# 12
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW3165
License Number StateTN

VIII. Authorized Official

Name: MR. GREGORY MOTLEY SR.
Title or Position: DIRECTOR
Credential: LMSW, LADC, MAC, MED
Phone: 901-728-5554