Provider Demographics
NPI:1386295368
Name:BRANCO, TYLER JOSEPH (MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JOSEPH
Last Name:BRANCO
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 KATELLA AVE STE 103B
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6828
Mailing Address - Country:US
Mailing Address - Phone:714-368-6967
Mailing Address - Fax:
Practice Address - Street 1:5212 KATELLA AVE STE 103B
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6828
Practice Address - Country:US
Practice Address - Phone:714-368-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-22
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126466106H00000X
CA114458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist