Provider Demographics
NPI:1750821146
Name:BRUNER, CLAY LEWIS
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:LEWIS
Last Name:BRUNER
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 1:5001 GOLDEN TRIANGLE BLVD
Mailing Address - Street 2:APT 811
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4481
Mailing Address - Country:US
Mailing Address - Phone:817-202-3891
Mailing Address - Fax:
Practice Address - Street 1:5001 GOLDEN TRIANGLE BLVD
Practice Address - Street 2:APT 811
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4481
Practice Address - Country:US
Practice Address - Phone:817-202-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst