Provider Demographics
NPI:1184445173
Name:BRANCH WELLNESS LLC
Entity type:Organization
Organization Name:BRANCH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:405-401-4693
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0132
Mailing Address - Country:US
Mailing Address - Phone:405-401-4693
Mailing Address - Fax:
Practice Address - Street 1:1900 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-5320
Practice Address - Country:US
Practice Address - Phone:405-401-4693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty