Provider Demographics
NPI:1326513623
Name:BRUNER, TRISHA (LMFT)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:BRUNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 E CANNON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3723
Mailing Address - Country:US
Mailing Address - Phone:847-530-1616
Mailing Address - Fax:
Practice Address - Street 1:2211 E HIGHLAND AVE STE 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4833
Practice Address - Country:US
Practice Address - Phone:847-530-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist