Life Branch Inc.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

35072 Issued in TX

Legal business name

LIFE BRANCH INC.

Practice address

5262 South Staples
Suite 300
Corpus Christi, TX 78411-4116

Phone

(361) 332-6551

Fax

(361) 687-2563

NPI assigned

Feb 21, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Christina Lea Ketchum, LCSW

Title

Owner

Phone

(361) 332-6551

Specialties & licenses 1

Addresses

Other names 1

• Christina Ketchum, LCSW PLLC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1144560574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5437 KING ACRES DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784146301",
            "telephone_number": "361-332-6551",
            "fax_number": "361-687-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5262 SOUTH STAPLES",
            "address_2": "SUITE 300",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784114116",
            "telephone_number": "361-332-6551",
            "fax_number": "361-687-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BRANCH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-21",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "KETCHUM",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "361-332-6551",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "35072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christina Ketchum, LCSW PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Social Worker in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.