Provider Demographics
NPI:1619395118
Name:BRANNAN, NANCY
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:BRANNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, ED; LAC
Mailing Address - Street 1:200 E MAIN AVE
Mailing Address - Street 2:SUITE #204
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3857
Mailing Address - Country:US
Mailing Address - Phone:701-989-5648
Mailing Address - Fax:
Practice Address - Street 1:200 E MAIN AVE
Practice Address - Street 2:SUITE #204
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3857
Practice Address - Country:US
Practice Address - Phone:701-989-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1565-COUNSELOR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)