Organization
BRANCHES OF LIFE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY MOTLEY SR. LMSW, LADC, MAC, MED (DIRECTOR)
(901) 728-5554
Entity
Organization
Contact information
Practice address
1203 POPLAR AVE STE 5, MEMPHIS, TN 38104-7278
(901) 728-5554
(901) 728-6011
Mailing address
PO BOX 40632, MEMPHIS, TN 38174-0632
(901) 728-5554
(901) 728-6011
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
AC23491
TN
101Y00000X
Counselor
F16765
TN
101YA0400X
Addiction (Substance Use Disorder) Counselor
308
OK
101YA0400X
Addiction (Substance Use Disorder) Counselor
BC23491
TN
101YM0800X
Mental Health Counselor
LPC908
TN
1041C0700X
Clinical Social Worker
CSW
TN
1041C0700X
Clinical Social Worker
F20063
TN
1041C0700X
Clinical Social Worker
LSW1502
AR
1041C0700X
Clinical Social Worker
Primary
LSW3165
TN
1041C0700X
Clinical Social Worker
LSW3185
TN
106H00000X
Marriage & Family Therapist
LPC908
TN
170100000X
Ph.D. Medical Genetics
MD010748
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11549639
CAQH-AETNA
TN
01
—
11587744
J.D. FARLEY INSURANCE
TN
05
—
3728928
—
TN
01
—
4114450
BLUE CROSS BLUE SHIELD
TN
01
—
561112000
MAGELLAN
TN
01
—
60054
AETNA
TN
Enumeration date
10/24/2006
Last updated
06/22/2010
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