Provider Demographics
NPI:1639576572
Name:ARCHWAY COUNSELING CENTER
Entity Type:Organization
Organization Name:ARCHWAY COUNSELING CENTER
Other - Org Name:J. PHYLLIS BRANNEN, LCSW, CAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:J.
Authorized Official - Middle Name:PHYLLIS
Authorized Official - Last Name:BRANNEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CAP
Authorized Official - Phone:813-482-2507
Mailing Address - Street 1:274 N BABCOCK ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:274 N BABCOCK ST
Practice Address - Street 2:SUITE C
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7334
Practice Address - Country:US
Practice Address - Phone:321-313-0953
Practice Address - Fax:321-952-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1805AD627401251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health