Organization
BRANCH & VINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDMUND JASON STAMPER LPC-MH, NCC, QMHP (FOUNDER MEMBER)
(605) 600-3733
Entity
Organization
Contact information
Practice address
2040 W MAIN ST, STE 311, RAPID CITY, SD 57702
(605) 600-3733
Mailing address
2040 W MAIN ST, STE 311, RAPID CITY, SD 57702
(605) 600-3733
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
03/26/2022
Last updated
03/26/2022
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