| Doctor Name: | MRS. SUSAN DIANE BRANAM |
| NPI Number: | 1376775775 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC, LCSW |
| License Number: | 594 |
| Business Practice Address: | 2320 County Road 1254 Blanchard, OK - 730103019 |
| Business Phone Number: | 9183027080 |
| Business Fax Number: | 4053922936 |
| Mailing Address: | 2320 County Road 1254, BLANCHARD |
| State: | OK |
| Postal Code: | 730103019 |
| Phone Number: | 9183027080 |
| Fax Number: | 4053922936 |
| NPI Enumeration Date: | 08/18/2009 |
| NPI Last Update Date: | 10/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 594 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |