=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588558274
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRANCH HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2025
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 W PLATT ST # 189
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-2292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-416-9934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 W PLATT ST # 189
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-2292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-416-9934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE CHAIRMAN
-----------------------------------------------------
Name | NATHANAEL GYURKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-416-9934
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------