Provider Demographics
NPI:1629254198
Name:BRANCH, LAURIE M (MA, LPC, CACIII)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:M
Last Name:BRANCH
Suffix:
Gender:F
Credentials:MA, LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 ORCHARD CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5821
Mailing Address - Country:US
Mailing Address - Phone:303-444-7256
Mailing Address - Fax:303-444-7439
Practice Address - Street 1:100 ARAPAHOE AVE STE 7
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5862
Practice Address - Country:US
Practice Address - Phone:303-444-7256
Practice Address - Fax:303-444-7439
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 1434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional