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NPI Code Detail

MEDICARE: BRANDEN SMITH

MEDICARE: BRANDEN SMITH
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
1101YP2500XProfessional Counselor
2101YP2500XProfessional Counselor4337MN

General Provider Information

NPI Number : 1861063430
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDEN SMITH
Provider Business Mailing Address
First Line : 113 MINNESOTA AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-2420
Country : US
Telephone Number : 218-849-9810
Fax Number :
Provider Business Practice Location Address
First Line : 1041 HAWK ST
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-6958
Country : US
Telephone Number : 218-844-6853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2021
Last Update Date : 06/09/2025

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Directions to “ BRANDEN SMITH ” Practice Location

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