Provider Demographics
NPI:1063221042
Name:BRANBACK, HALEY (MS, LPC, CRC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:BRANBACK
Suffix:
Gender:F
Credentials:MS, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8809
Mailing Address - Country:US
Mailing Address - Phone:414-331-3265
Mailing Address - Fax:
Practice Address - Street 1:6525 W BLUEMOUND RD STE 32
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-4073
Practice Address - Country:US
Practice Address - Phone:414-533-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10214-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional