Provider Demographics
NPI:1083636252
Name:BRUNS, TROY A (MA)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:BRUNS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4564
Mailing Address - Country:US
Mailing Address - Phone:715-833-7111
Mailing Address - Fax:715-833-0454
Practice Address - Street 1:1030 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4564
Practice Address - Country:US
Practice Address - Phone:715-833-7111
Practice Address - Fax:715-833-0454
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11932101YA0400X
WI3161-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40990800Medicaid