Provider Demographics
NPI:1255498226
Name:BRANSCOM, NANCY THERESA
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:THERESA
Last Name:BRANSCOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 E RIVER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5827
Mailing Address - Country:US
Mailing Address - Phone:520-292-0840
Mailing Address - Fax:
Practice Address - Street 1:268 E RIVER RD STE 160
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5827
Practice Address - Country:US
Practice Address - Phone:520-292-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT 0167106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist