Provider Demographics
NPI:1598943995
Name:PRUNTY, BRETT JOSEPH (MED LPC CRC CADC II)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:JOSEPH
Last Name:PRUNTY
Suffix:
Gender:M
Credentials:MED LPC CRC CADC II
Other - Prefix:MR
Other - First Name:BRETT
Other - Middle Name:J
Other - Last Name:PRUNTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED LPC CRC CADC II
Mailing Address - Street 1:731 NW FRANKLIN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2752
Mailing Address - Country:US
Mailing Address - Phone:541-610-2512
Mailing Address - Fax:
Practice Address - Street 1:731 NW FRANKLIN AVE STE 107
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2752
Practice Address - Country:US
Practice Address - Phone:541-610-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCADC II # 05-R-03101YA0400X
ORLPC (OR) C-1765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)