Provider Demographics
NPI:1376775775
Name:BRANAM, SUSAN DIANE (LADC, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DIANE
Last Name:BRANAM
Suffix:
Gender:F
Credentials:LADC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 COUNTY ROAD 1254
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-3019
Mailing Address - Country:US
Mailing Address - Phone:918-302-7080
Mailing Address - Fax:405-392-2936
Practice Address - Street 1:2320 COUNTY ROAD 1254
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-3019
Practice Address - Country:US
Practice Address - Phone:918-302-7080
Practice Address - Fax:405-392-2936
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK594101YA0400X
OK2913101YM0800X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist