MEDICARE: AMY BRANSON MA, LAC, 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	101Y00000X	Counselor	LAC-20491	AZ

General Provider Information

NPI Number	:	1588388011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BRANSON MA, LAC, CRC

Provider Business Mailing Address
First Line	:	5313 E RANCHO DEL ORO DR
Second Line	:
City	:	CAVE CREEK
State	:	AZ
Zip	:	85331-5550
Country	:	US
Telephone Number	:	480-707-2373
Fax Number	:

Provider Business Practice Location Address
First Line	:	5313 E RANCHO DEL ORO DR
Second Line	:
City	:	CAVE CREEK
State	:	AZ
Zip	:	85331-5550
Country	:	US
Telephone Number	:	480-707-2373
Fax Number	:

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

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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