MEDICARE: HALEY BRANBACK MS, LPC, CRC

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	101YP2500X	Professional Counselor	10214-125	WI

General Provider Information

NPI Number	:	1063221042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY BRANBACK MS, LPC, CRC

Provider Business Mailing Address
First Line	:	9905 S 76TH ST
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132-8809
Country	:	US
Telephone Number	:	414-331-3265
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 W BLUEMOUND RD STE 32
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-4073
Country	:	US
Telephone Number	:	414-533-7030
Fax Number	:

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

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	01/03/2025

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