Provider Demographics
NPI:1073909644
Name:BERT BRUNO
Entity Type:Organization
Organization Name:BERT BRUNO
Other - Org Name:CASTLE COUNTRY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-650-6562
Mailing Address - Street 1:375 S CARBON AVE
Mailing Address - Street 2:SUITE B-11
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 S CARBON AVE
Practice Address - Street 2:SUITE B-11
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2909
Practice Address - Country:US
Practice Address - Phone:435-637-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT266606-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT266606-3501OtherDOPL