MEDICARE: BYRON BRANHAM

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	101YM0800X	Mental Health Counselor	0701006597	VA
2	101YP2500X	Professional Counselor	6401225656	MI

General Provider Information

NPI Number	:	1093161937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON BRANHAM

Provider Business Mailing Address
First Line	:	1812 BURWILLOW DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8945
Country	:	US
Telephone Number	:	757-636-6729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 BURWILLOW DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8945
Country	:	US
Telephone Number	:	757-636-6729
Fax Number	:

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

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	06/24/2026

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