Provider Demographics
NPI:1881115285
Name:BRANEY, BENJAMIN GEORGE
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:GEORGE
Last Name:BRANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12734 N MACARTHUR BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2919
Mailing Address - Country:US
Mailing Address - Phone:909-223-4273
Mailing Address - Fax:
Practice Address - Street 1:932 W STATE HIGHWAY 152
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-2301
Practice Address - Country:US
Practice Address - Phone:405-577-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60738059101Y00000X, 106H00000X
ORR5432101Y00000X
106S00000X
OK11780106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2097590Medicaid