Provider Demographics
NPI:1770638355
Name:BRANNEN, VALERIE D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:D
Last Name:BRANNEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:D
Other - Last Name:BRANNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:104 MALLARD CV
Mailing Address - Street 2:
Mailing Address - City:BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72411-9480
Mailing Address - Country:US
Mailing Address - Phone:870-819-1876
Mailing Address - Fax:870-570-0359
Practice Address - Street 1:603 W. FLEEMAN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442
Practice Address - Country:US
Practice Address - Phone:870-570-0358
Practice Address - Fax:870-570-0359
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2091-C101YM0800X, 1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5R939OtherBCBS
AR227728719Medicaid