Provider Demographics
NPI:1609940048
Name:BRUNEAU, RALPH EUGENE III (PHD MFT)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EUGENE
Last Name:BRUNEAU
Suffix:III
Gender:M
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 N. LARCHMONT BLVD.
Mailing Address - Street 2:STE. 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3707
Mailing Address - Country:US
Mailing Address - Phone:323-962-9619
Mailing Address - Fax:323-463-4489
Practice Address - Street 1:252 N. LARCHMONT BLVD.
Practice Address - Street 2:STE. 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3707
Practice Address - Country:US
Practice Address - Phone:323-962-9619
Practice Address - Fax:323-463-4489
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33596106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist