Provider Demographics
NPI:1376081547
Name:BRANCH, CHASIDY
Entity Type:Individual
Prefix:
First Name:CHASIDY
Middle Name:
Last Name:BRANCH
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 1:640 US HIGHWAY 51 BYP E STE M
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2067
Mailing Address - Country:US
Mailing Address - Phone:731-285-6535
Mailing Address - Fax:731-285-6532
Practice Address - Street 1:640 U.S. HIGHWAY 51 BYPASS E. SUITE M
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-285-6535
Practice Address - Fax:731-285-6532
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)