Basic Information
| Provider Information | |||||||||
| NPI: | 1780267278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANSCOMB | ||||||||
| FirstName: | KAMRON | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11640 MENLO AVE APT 6 | ||||||||
| Address2: | |||||||||
| City: | HAWTHORNE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902500905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242216452 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3756 SANTA ROSALIA DR STE 628 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900083606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232938771 | ||||||||
| FaxNumber: | 3232938780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2021 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT125516 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.