Provider Demographics
NPI:1104181122
Name:BRANCH, SEAN LEAVLLE
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:LEAVLLE
Last Name:BRANCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 MCLEOD DR STE 4&5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4430
Mailing Address - Country:US
Mailing Address - Phone:702-437-0341
Mailing Address - Fax:
Practice Address - Street 1:6330 MCLEOD DR STE 4&5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4430
Practice Address - Country:US
Practice Address - Phone:702-437-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor