Provider Demographics
NPI:1669026316
Name:BRANCH, MARCUS
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:BRANCH
Suffix:
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 1:7872 KENNETT SQ
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-5015
Mailing Address - Country:US
Mailing Address - Phone:503-810-3569
Mailing Address - Fax:
Practice Address - Street 1:7872 KENNETT SQ
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-5015
Practice Address - Country:US
Practice Address - Phone:503-810-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)