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General NPI Number Information
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NPI Number | 1497889968
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Entity Type | Individual
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Provider Name | MARILYN E BRANNON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 534 TREJO STREET SUITE 100
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-356-3776
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Fax | 208-356-9498
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Provider Business Mailing Address
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Address Line | 534 TREJO STREET SUITE 100
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-356-3776
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Fax | 208-356-9498
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 229
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY 229
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License Number State | ID
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