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General NPI Number Information
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NPI Number | 1104273234
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Entity Type | Organization
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Legal Business Name | THE BRANCH HOUSE
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 562 CENTER ST
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City | COLLIERVILLE
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State | TN
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Zip | 38017
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Country | US
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Telephone | 678-834-7615
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Fax | 678-834-7616
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Provider Business Mailing Address
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Address Line | 5737 OLD NATIONAL HIGHWAY 300
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City | ATLANTA
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State | GA
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Zip | 30349
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Country | US
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Telephone | 678-834-7615
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Fax | 678-834-7616
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NIKKI WRIGHT
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Credential |
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Telephone | 678-834-7615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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