Provider Demographics
NPI:1932111747
Name:BRANAMAN, TIM (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:
Last Name:BRANAMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W CAMPBELL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 W CAMPBELL RD STE 2
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3357
Practice Address - Country:US
Practice Address - Phone:972-669-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22443103TF0200X
TX1143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86616AOtherBLUE CROSS