Provider Demographics
NPI:1497493803
Name:BRUNZ, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BRUNZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S SYCAMORE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-3711
Mailing Address - Country:US
Mailing Address - Phone:605-553-6243
Mailing Address - Fax:
Practice Address - Street 1:1500 S SYCAMORE AVE STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-3711
Practice Address - Country:US
Practice Address - Phone:605-553-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist