Provider Demographics
NPI:1720383359
Name:BRUINING, LABRENDA LOU (LMSW)
Entity Type:Individual
Prefix:
First Name:LABRENDA
Middle Name:LOU
Last Name:BRUINING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 NO NAME RD
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-9490
Mailing Address - Country:US
Mailing Address - Phone:231-425-4008
Mailing Address - Fax:231-425-4008
Practice Address - Street 1:123 W LUDINGTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2021
Practice Address - Country:US
Practice Address - Phone:231-425-4008
Practice Address - Fax:231-425-4008
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010804541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical