Provider Demographics
NPI:1437228467
Name:BRUNE, BETTY JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:BRUNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 BRIGGS ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1221
Mailing Address - Country:US
Mailing Address - Phone:210-924-3556
Mailing Address - Fax:210-924-3557
Practice Address - Street 1:94 BRIGGS ST
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1221
Practice Address - Country:US
Practice Address - Phone:210-924-3556
Practice Address - Fax:210-924-3557
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6627103TS0200X
TX25235103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool