Provider Demographics
NPI:1164942686
Name:MIND/MOOD COUNSELING & COACHING CENTERS OF SWFL, PLLC
Entity Type:Organization
Organization Name:MIND/MOOD COUNSELING & COACHING CENTERS OF SWFL, PLLC
Other - Org Name:REGINALD BRUNO, EDD, LCSW, MCAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / MANAGER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MCAP
Authorized Official - Phone:239-770-7267
Mailing Address - Street 1:10970 S. CLEVELAND AVE. #303
Mailing Address - Street 2:BRUNO AND PRADO, PLLC (ATTN: KATHY BRUNO)
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-770-7267
Mailing Address - Fax:
Practice Address - Street 1:9990 COCONUT ROAD
Practice Address - Street 2:ATTN. EMILY - BES MANAGER
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-770-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9243251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health