Provider Demographics
NPI:1134012339
Name:BRANNAN, LONZIE WILLARD
Entity type:Individual
Prefix:
First Name:LONZIE
Middle Name:WILLARD
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HIGHVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-6064
Mailing Address - Country:US
Mailing Address - Phone:614-587-7778
Mailing Address - Fax:740-212-8808
Practice Address - Street 1:65 HIGHVIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-6064
Practice Address - Country:US
Practice Address - Phone:614-587-7778
Practice Address - Fax:740-212-8808
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.179039101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)