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General NPI Number Information
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NPI Number | 1104134410
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY BRANCHAUD LPC
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Gender | Male
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 2489 RICE ST SUITE 90
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City | ROSEVILLE
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State | MN
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Zip | 55113-3738
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Country | US
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Telephone | 651-528-7550
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Fax |
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Provider Business Mailing Address
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Address Line | 15182 FARNHAM AVE N
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City | HUGO
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State | MN
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Zip | 55038-6306
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Country | US
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Telephone | 763-221-8834
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC00950
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License Number State | MN
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