Provider Demographics
NPI:1902351216
Name:BRANCHES OF GROWTH, LLC
Entity Type:Organization
Organization Name:BRANCHES OF GROWTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:315-415-0308
Mailing Address - Street 1:113 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:N SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2370
Mailing Address - Country:US
Mailing Address - Phone:315-415-0308
Mailing Address - Fax:315-883-0711
Practice Address - Street 1:113 CHURCH ST
Practice Address - Street 2:
Practice Address - City:N SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2370
Practice Address - Country:US
Practice Address - Phone:315-415-0308
Practice Address - Fax:315-883-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty