MEDICARE: DR. LEE BRANHAM PHD

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	103TC0700X	Clinical Psychologist	30	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174534861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE BRANHAM PHD

Provider Business Mailing Address
First Line	:	10543 POPPLETON AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-1033
Country	:	US
Telephone Number	:	402-391-6467
Fax Number	:	402-391-5833

Provider Business Practice Location Address
First Line	:	10543 POPPLETON AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-1033
Country	:	US
Telephone Number	:	402-391-6467
Fax Number	:	402-391-5833

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. LEE BRANHAM PHD” Practice Location

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