Provider Demographics
NPI:1245412022
Name:BRUNN JOINT VENTURE
Entity Type:Organization
Organization Name:BRUNN JOINT VENTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-772-2043
Mailing Address - Street 1:305 LONDONDERRY DR
Mailing Address - Street 2:STE 2
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7929
Mailing Address - Country:US
Mailing Address - Phone:254-772-2043
Mailing Address - Fax:254-772-4671
Practice Address - Street 1:305 LONDONDERRY DR
Practice Address - Street 2:STE 2
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7929
Practice Address - Country:US
Practice Address - Phone:254-772-2043
Practice Address - Fax:254-772-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty