Provider Demographics
NPI:1235306978
Name:BRUNER, KEVIN J (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:BRUNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 IRELAND WAY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6011
Mailing Address - Country:US
Mailing Address - Phone:469-757-4525
Mailing Address - Fax:469-757-4525
Practice Address - Street 1:100 N 1ST ST
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4473
Practice Address - Country:US
Practice Address - Phone:469-757-4525
Practice Address - Fax:469-757-4525
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional