Provider Demographics
NPI:1760511406
Name:BRUNNER, KIRSTEN A (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:A
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10908 PRESTON TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-1627
Mailing Address - Country:US
Mailing Address - Phone:512-280-7047
Mailing Address - Fax:
Practice Address - Street 1:3001 S LAMAR BLVD STE 220
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4631
Practice Address - Country:US
Practice Address - Phone:512-693-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional