Provider Demographics
NPI:1164587093
Name:BRANSON, MARY (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 NURSERY RD
Mailing Address - Street 2:SUITE B-700
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1946
Mailing Address - Country:US
Mailing Address - Phone:832-326-5972
Mailing Address - Fax:281-419-0879
Practice Address - Street 1:431 NURSERY RD
Practice Address - Street 2:SUITE B-700
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1946
Practice Address - Country:US
Practice Address - Phone:832-326-5972
Practice Address - Fax:281-419-0879
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15473101YP2500X
TX4880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10009415Medicaid
TX0281214-01Medicaid