Provider Demographics
NPI:1417286469
Name:BRUNER, BASIL KEITH (MHR)
Entity Type:Individual
Prefix:MR
First Name:BASIL
Middle Name:KEITH
Last Name:BRUNER
Suffix:
Gender:M
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 BRANIFF DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1242
Mailing Address - Country:US
Mailing Address - Phone:405-615-7367
Mailing Address - Fax:
Practice Address - Street 1:6408 BRANIFF DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1243
Practice Address - Country:US
Practice Address - Phone:405-615-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor