Provider Demographics
NPI:1427360155
Name:BRUNO, DAVID BRIAN (LPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:BRUNO
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 1:26394 HIGHWAY C
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-8655
Mailing Address - Country:US
Mailing Address - Phone:573-247-4540
Mailing Address - Fax:573-458-2488
Practice Address - Street 1:616 N PINE ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3136
Practice Address - Country:US
Practice Address - Phone:573-247-4540
Practice Address - Fax:573-458-2488
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010018847101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor