Provider Demographics
NPI:1679701668
Name:BRANSON, JENNIFER PUALANI (LPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PUALANI
Last Name:BRANSON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:PUALANI
Other - Last Name:ARANITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:1911 WILLIAMS DR
Mailing Address - Street 2:STE #165
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2612
Mailing Address - Country:US
Mailing Address - Phone:877-327-4747
Mailing Address - Fax:805-981-9268
Practice Address - Street 1:1911 WILLIAMS DR
Practice Address - Street 2:STE #165
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2612
Practice Address - Country:US
Practice Address - Phone:877-327-4747
Practice Address - Fax:805-981-9268
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health