Provider Demographics
NPI:1538743992
Name:BRANNAN, JEFFREY (LPC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 TANGLEWOOD CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2324
Mailing Address - Country:US
Mailing Address - Phone:706-442-2297
Mailing Address - Fax:
Practice Address - Street 1:1355 TERRELL MILL RD SE # 1460
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5496
Practice Address - Country:US
Practice Address - Phone:470-893-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional