Provider Demographics
NPI:1568568012
Name:BRUHN, DAVID MICHAEL
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:BRUHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GULLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3747
Mailing Address - Country:US
Mailing Address - Phone:843-252-0405
Mailing Address - Fax:843-482-0385
Practice Address - Street 1:100 GULLEDGE ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3747
Practice Address - Country:US
Practice Address - Phone:843-252-0405
Practice Address - Fax:843-482-0385
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional