Provider Demographics
NPI:1346974003
Name:BRUNING, MICHAEL T (MED, BSL)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:BRUNING
Suffix:
Gender:M
Credentials:MED, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6001
Mailing Address - Country:US
Mailing Address - Phone:570-502-2326
Mailing Address - Fax:
Practice Address - Street 1:740 BRESSLER ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3741
Practice Address - Country:US
Practice Address - Phone:570-502-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health