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General NPI Number Information
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NPI Number | 1669677696
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Entity Type | Organization
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Legal Business Name | E M BRANCH & ASSOCIATES
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 3139 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60655-2205
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Country | US
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Telephone | 773-238-1100
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Fax | 773-238-4095
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Provider Business Mailing Address
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Address Line | 3139 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60655-2205
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Country | US
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Telephone | 773-238-1100
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Fax | 773-238-4095
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. BRENDA T. THOMPSON
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Credential | MSW
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Telephone | 773-238-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149.002225
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License Number State | IL
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