Provider Demographics
NPI:1568468627
Name:BRANSON, DANA C (LCSW, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:C
Last Name:BRANSON
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S SPRIGG ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6212
Mailing Address - Country:US
Mailing Address - Phone:573-651-4177
Mailing Address - Fax:573-651-3636
Practice Address - Street 1:20 S SPRIGG ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6212
Practice Address - Country:US
Practice Address - Phone:573-651-4177
Practice Address - Fax:573-651-3636
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0056631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111503OtherFIRST HEALTH/COVENTRY
MO494750326Medicaid
431116734OtherUNITED BEHAVIORAL HEALTH
431116734OtherEAP CERIDIAN
43111673463857AOtherTRI CARE WEST
162909OtherBLUE CROSS BLUE SHIELD
431116734OtherEAP CONCERN
431116734OtherNEW DIRECTIONS
51130OtherMOUNT CARMEL
11333199OtherCAQH
431116734OtherEAP NEW DIRECTIONS
431116734OtherEAP WELLPOINT
431116734OtherEAP INTERFACE
713386OtherHEALTHLINK PPO