Provider Demographics
NPI:1508015249
Name:BRANCH, GEORGE ALAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ALAN
Last Name:BRANCH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WINDY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2594
Mailing Address - Country:US
Mailing Address - Phone:817-894-5017
Mailing Address - Fax:682-367-1010
Practice Address - Street 1:1505 WINDY MEADOWS DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2594
Practice Address - Country:US
Practice Address - Phone:817-894-5017
Practice Address - Fax:682-367-1010
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional