Individual
MARILYN E BRANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
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
103T00000X
Psychologist
PSY 229
ID
103TC1900X
Counseling Psychologist
Primary
PSY 229
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010016770
REGENCE BLUE SHIELD OF ID
ID
01
—
N2290
BLUE CROSS OF IDAHO
ID
Enumeration date
03/15/2007
Last updated
09/11/2025
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