Provider Demographics
NPI:1629651195
Name:BRANKLINE, ROBERT J JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BRANKLINE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41452 CREEKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5787
Mailing Address - Country:US
Mailing Address - Phone:225-337-5254
Mailing Address - Fax:
Practice Address - Street 1:43043 PELICAN LAKES CT
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8578
Practice Address - Country:US
Practice Address - Phone:225-337-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health