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1972938132 NPI number — KELLY LYNN BRANCH M.A., LPC, LLMFT

NPI Number: 1972938132
Health Care Provider/Practitioner: KELLY LYNN BRANCH M.A., LPC, LLMFT

Information about “1972938132” NPI (KELLY LYNN BRANCH M.A., LPC, LLMFT) exists in 1972938132 in HTML format HTML  |  1972938132 in plain Text format TXT  |  1972938132 in PDF (Portable Document Format) PDF  |  1972938132 in an XML format XML  formats.

NPI Number : 1972938132 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972938132",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRANCH",
    "FirstName": "KELLY",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.A., LPC, LLMFT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "AMES",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "8488 TUCKER CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JENISON",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49428-8678",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "616-299-4305",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "901 EASTERN AVE NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GRAND RAPIDS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49503-1201",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "616-299-4305",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/06/2013",
    "LastUpdateDate": "09/06/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "6401012214",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "4101006468",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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