Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301003184 | MI |
NPI | 1164458808 |
---|---|
Provider Name | Gayle Oliver-Brannon |
First Address | Belleville, MI 48112-1402 |
Second Address | Belleville, MI 48111-2921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 23/09/2014 |