Basic Information
Provider Information
NPI: 1902351216
EntityType: 2
ReplacementNPI:  
OrganizationName: BRANCHES OF GROWTH, LLC
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Mailing Information
Address1: 113 CHURCH ST
Address2:  
City: N SYRACUSE
State: NY
PostalCode: 132122370
CountryCode: US
TelephoneNumber: 3154150308
FaxNumber: 3158830711
Practice Location
Address1: 113 CHURCH ST
Address2:  
City: N SYRACUSE
State: NY
PostalCode: 132122370
CountryCode: US
TelephoneNumber: 3154150308
FaxNumber: 3158830711
Other Information
ProviderEnumerationDate: 08/17/2016
LastUpdateDate: 04/07/2020
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: HYATT
AuthorizedOfficialFirstName: KATHERINE
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AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 3154150308
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: LMHC
NPICertificationDate: 04/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X005499NYY193400000X SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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