Provider Demographics
NPI:1356674949
Name:BRANCH, MICHELLE (MS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:BRANCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BURKHALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:27777 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5326
Mailing Address - Country:US
Mailing Address - Phone:248-436-4400
Mailing Address - Fax:
Practice Address - Street 1:4530 E MUIRWOOD DR STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:480-610-6981
Practice Address - Fax:480-898-7419
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2020-09-30
Deactivation Date:2020-09-22
Deactivation Code:
Reactivation Date:2020-09-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool