Organization
BRANNON & BRANNON PSYCHOLOGICAL SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES M BRANNON ED.D. (SECRETARY)
(208) 356-3776
Entity
Organization
Contact information
Practice address
534 TREJO STREET, SUITE 100, REXBURG, ID 83440
(208) 356-3776
(208) 356-9498
Mailing address
534 TREJO STREET, SUITE 100, REXBURG, ID 83440
(208) 356-3776
(208) 356-9498
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002803600
—
ID
Enumeration date
03/14/2007
Last updated
10/29/2019
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