Provider Demographics
NPI:1073613782
Name:BRUNER, JAMES P (LPC, LICDC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:BRUNER
Suffix:
Gender:M
Credentials:LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IMA-E, SFIM-EU-HR (SAIC-ASACS0
Mailing Address - Street 2:UNIT 29353 BOX 200
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09014-9353
Mailing Address - Country:US
Mailing Address - Phone:01149622-116-3912
Mailing Address - Fax:01149622-157-8943
Practice Address - Street 1:IMA-E, SFIM-EU-HR (SAIC-ASACS0
Practice Address - Street 2:UNIT 29353 BOX 200
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09014-9353
Practice Address - Country:US
Practice Address - Phone:01149622-116-3912
Practice Address - Fax:01149622-157-8943
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1300101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor