Provider Demographics
NPI:1588451124
Name:BRANNON, JAMES (LEP, PPS, MA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BRANNON
Suffix:
Gender:M
Credentials:LEP, PPS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ATLANTICA DR S
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-7801
Mailing Address - Country:US
Mailing Address - Phone:559-304-4878
Mailing Address - Fax:
Practice Address - Street 1:415 ATLANTICA DR S
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-7801
Practice Address - Country:US
Practice Address - Phone:559-304-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4570103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty