Provider Demographics
NPI:1306166160
Name:BRANCHES COUNSELING PLLC
Entity type:Organization
Organization Name:BRANCHES COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LMSW
Authorized Official - Phone:734-377-4134
Mailing Address - Street 1:16801 NEWBURGH RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1606
Mailing Address - Country:US
Mailing Address - Phone:734-377-4134
Mailing Address - Fax:
Practice Address - Street 1:16801 NEWBURGH RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1606
Practice Address - Country:US
Practice Address - Phone:734-377-4134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-01551101YA0400X
MI204697101YA0400X
IN34005756A1041C0700X
MI0784311041C0700X
MI0917731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34005756AOtherLICENSED CLINICAL SOCIAL WORKER
MI091773OtherLICENSED MASTERS SOCIAL WORKER CLINICAL/MACRO
MI078431OtherLICENSED MASTERS SOCIAL WORKER CLINICAL/MACRO