Provider Demographics
NPI:1295356657
Name:BRANHAM, TONYA R (LPCC, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:R
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:LPCC, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MAIN ST STE 103-105
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1780
Mailing Address - Country:US
Mailing Address - Phone:859-533-6366
Mailing Address - Fax:
Practice Address - Street 1:110 E MAIN ST STE 103-109
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1780
Practice Address - Country:US
Practice Address - Phone:859-533-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261970101Y00000X, 101YP2500X
FL22602101YM0800X
LA9879101YP2500X
KY280850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100736670Medicaid