MEDICARE: MR. PHILLIP CURTIS BRAUN JR. LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	4700	SC

General Provider Information

NPI Number	:	1023503125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILLIP CURTIS BRAUN JR. LMFT

Provider Business Mailing Address
First Line	:	198 ROPER MOUNTAIN ROAD EXT STE C
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-6912
Country	:	US
Telephone Number	:	864-381-8321
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 ROPER MOUNTAIN ROAD EXT SUITE C
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1463
Country	:	US
Telephone Number	:	864-381-8321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2018
Last Update Date	:	08/14/2019

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