| Brannon & Brannon Psychological Services Pa | |
|
534 Trejo Street Suite 100 Rexburg ID 83440 | |
| (208) 356-3776 | |
| (208) 356-9498 |
| Full Name | Brannon & Brannon Psychological Services Pa |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 534 Trejo Street, Rexburg, Idaho |
| Authorized Official Name and Position | James M Brannon (SECRETARY) |
| Authorized Official Contact | 2083563776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brannon & Brannon Psychological Services Pa 534 Trejo Street Suite 100 Rexburg ID 83440 Ph: (208) 356-3776 | Brannon & Brannon Psychological Services Pa 534 Trejo Street Suite 100 Rexburg ID 83440 Ph: (208) 356-3776 |
| NPI Number | 1023141116 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 10/29/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023141116 | NPI | - | NPPES |
| 002803600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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