Provider Demographics
NPI:1396896718
Name:BRANNON, RACHEL MILLER (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MILLER
Last Name:BRANNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2803
Mailing Address - Country:US
Mailing Address - Phone:208-720-3225
Mailing Address - Fax:
Practice Address - Street 1:10300 N CENTRAL EXPY STE 280
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8666
Practice Address - Country:US
Practice Address - Phone:214-651-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686181041C0700X
IDLCSW-292811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical