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General NPI Number Information
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NPI Number | 1720449986
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Entity Type | Individual
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Provider Name | MYRA BRAUN MS, LPC-IT, SAC-IT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 1541 ANNEX RD
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City | JEFFERSON
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State | WI
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Zip | 53549-9803
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Country | US
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Telephone | 920-674-3105
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Fax | 920-674-6113
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Provider Business Mailing Address
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Address Line | 1541 ANNEX RD
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City | JEFFERSON
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State | WI
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Zip | 53549-9803
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Country | US
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Telephone | 920-674-3105
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Fax | 920-674-6113
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2731-226
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License Number State | WI
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