Look up the most recent NPI and PECOS records

Branches Of Life, Inc.

Social Worker

Behavioral Health & Social Service Providers

1203 Poplar Ave Ste 5, Memphis, TN 38104-7278

PECOS Enrollment

Based on the most recent information from CMS, provider Branches Of Life, Inc. does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1609959212
Provider Type
Organization
Full Name
Branches Of Life, Inc.

Subpart
No
Enumeration Date
10/24/2006
Last Updated
6/22/2010

Contact Information

Practice Location

1203 Poplar Ave Ste 5, Memphis, TN 38104-7278

(901) 728-5554

(901) 728-6011

Mailing Location

PO Box 40632, Memphis, TN 38174-0632

(901) 728-5554

(901) 728-6011

Authorized Official

Motley, Gregory (Director)

(901) 728-5554

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License LSW3165 Tennessee
Code 101Y00000X	Description Counselor Behavioral Health & Social Service Providers	License AC23491 Tennessee
Code 101Y00000X	Description Counselor Behavioral Health & Social Service Providers	License F16765 Tennessee
Code 101YA0400X	Description Counselor Behavioral Health & Social Service Providers	License 308 Oklahoma
Code 101YA0400X	Description Counselor Behavioral Health & Social Service Providers	License BC23491 Tennessee
Code 101YM0800X	Description Counselor Behavioral Health & Social Service Providers	License LPC908 Tennessee
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License CSW Tennessee
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License F20063 Tennessee
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License LSW3185 Tennessee
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License LSW1502 Arkansas
Code 106H00000X	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License LPC908 Tennessee
Code 170100000X	Description Medical Genetics, Ph.D. Medical Genetics Other Service Providers	License MD010748 Tennessee

Provider Identifiers

ID	Description	Issuer
ID 561112000	Description Other	Issuer MAGELLAN Tennessee
ID 11587744	Description Other	Issuer J.D. FARLEY INSURANCE Tennessee
ID 60054	Description Other	Issuer AETNA Tennessee
ID 3728928	Description Medicaid	Issuer Unlisted Tennessee
ID 11549639	Description Other	Issuer CAQH-AETNA Tennessee
ID 4114450	Description Other	Issuer BLUE CROSS BLUE SHIELD Tennessee

Branches Of Life, Inc.

PECOS Enrollment

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