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General NPI Number Information
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NPI Number | 1023503125
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Entity Type | Individual
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Provider Name | PHILLIP CURTIS BRAUN JR. LMFT
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Gender | Male
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Dates
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Enumeration Date | 06/30/2018
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 198 ROPER MOUNTAIN ROAD EXT SUITE C
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City | GREENVILLE
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State | SC
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Zip | 29615-1463
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Country | US
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Telephone | 864-381-8321
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Fax |
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Provider Business Mailing Address
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Address Line | 198 ROPER MOUNTAIN ROAD EXT STE C
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City | GREENVILLE
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State | SC
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Zip | 29615-6912
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Country | US
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Telephone | 864-381-8321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4700
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License Number State | SC
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