Provider Demographics
NPI:1013205483
Name:SPOKANE RESOURCE GROUP, PLLC
Entity Type:Organization
Organization Name:SPOKANE RESOURCE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:509-262-6406
Mailing Address - Street 1:1817 E SPRINGFIELD AVE
Mailing Address - Street 2:SUITE E.
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2913
Mailing Address - Country:US
Mailing Address - Phone:509-262-6406
Mailing Address - Fax:509-262-6406
Practice Address - Street 1:1817 E SPRINGFIELD AVE
Practice Address - Street 2:SUITE E.
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2913
Practice Address - Country:US
Practice Address - Phone:509-262-6406
Practice Address - Fax:509-262-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60115733103T00000X
WAAP60211296363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty