Basic Information
| Provider Information | |||||||||
| NPI: | 1235638149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANNON | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | AAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7319 SEYMOUR RD | ||||||||
| Address2: | |||||||||
| City: | SWARTZ CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484737652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107014035 | ||||||||
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| Practice Location | |||||||||
| Address1: | 529 MARTIN LUTHER KING BLVD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485022002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102385888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2018 | ||||||||
| LastUpdateDate: | 02/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.