Provider Demographics
NPI:1770020547
Name:BRANCH, STEVEN RUSSELL
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RUSSELL
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 1:216 S. SLOPE DRIVE
Mailing Address - Street 2:APT 2
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28607-9883
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:BLDG. 500 STE. 505
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-268-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health