Individual
MRS. PHEYNELL BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AAS, CSAC,CSIT
Contact information
Practice address
1650 WASINGTON AVE, RACINE, WI 53403
(262) 633-5001
Mailing address
6737 W WASHINGTON ST STE 2210, WEST ALLIS, WI 53214-5650
(414) 777-1570
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15476-133
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15662-132
WI
Other
Enumeration date
11/08/2013
Last updated
11/08/2013
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