Provider Demographics
NPI:1487957353
Name:BRANNAN, MICHAEL TERRENCE (MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TERRENCE
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1772 KINGSMILL DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6560
Mailing Address - Country:US
Mailing Address - Phone:863-205-9912
Mailing Address - Fax:863-533-7006
Practice Address - Street 1:1740 E EDGEWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3412
Practice Address - Country:US
Practice Address - Phone:863-205-9912
Practice Address - Fax:863-205-9912
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH8831OtherREGISTERED MENTAL HEALTH COUNSELOR INTERN