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NPI Code Detail

MEDICARE: JESSICA BRANCH M.A.

MEDICARE: JESSICA BRANCH M.A.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1548682404
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BRANCH M.A.
Provider Business Mailing Address
First Line : 13 S JEFFERSON AVE
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-3307
Country : US
Telephone Number : 931-644-8949
Fax Number :
Provider Business Practice Location Address
First Line : 13 S JEFFERSON AVE
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-3307
Country : US
Telephone Number : 931-644-8949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2014
Last Update Date : 01/13/2014

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