Provider Demographics
NPI:1700437712
Name:BRANSTON, JESSICA BETH
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:BETH
Last Name:BRANSTON
Suffix:
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 1:8122 S 107TH EAST AVE # 6H
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8302
Mailing Address - Country:US
Mailing Address - Phone:918-812-6923
Mailing Address - Fax:
Practice Address - Street 1:201 W 5TH ST STE 505
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-4277
Practice Address - Country:US
Practice Address - Phone:918-295-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health