Provider Demographics
NPI:1609959212
Name:BRANCHES OF LIFE, INC.
Entity Type:Organization
Organization Name:BRANCHES OF LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMSW, LADC, MAC, MED
Authorized Official - Phone:901-728-5554
Mailing Address - Street 1:PO BOX 40632
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-0632
Mailing Address - Country:US
Mailing Address - Phone:901-728-5554
Mailing Address - Fax:901-728-6011
Practice Address - Street 1:1203 POPLAR AVE STE 5
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7278
Practice Address - Country:US
Practice Address - Phone:901-728-5554
Practice Address - Fax:901-728-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAC23491101Y00000X
TNF16765101Y00000X
OK308101YA0400X
TNBC23491101YA0400X
TNLPC908101YM0800X, 106H00000X
TNCSW1041C0700X
TNF200631041C0700X
TNLSW31851041C0700X
TNLSW31651041C0700X
ARLSW15021041C0700X
TNMD010748170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN561112000OtherMAGELLAN
TN11587744OtherJ.D. FARLEY INSURANCE
TN60054OtherAETNA
TN3728928Medicaid
TN11549639OtherCAQH-AETNA
TN4114450OtherBLUE CROSS BLUE SHIELD