Provider Demographics
NPI:1134949241
Name:BRANHAM, EMILY GRACE I
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:GRACE
Last Name:BRANHAM
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 CRESTWOOD HILLS LN
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-6001
Mailing Address - Country:US
Mailing Address - Phone:479-715-9402
Mailing Address - Fax:
Practice Address - Street 1:1807 SW REGIONAL AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-7755
Practice Address - Country:US
Practice Address - Phone:479-268-4326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician