Provider Demographics
NPI:1801042049
Name:BRAUN, DUSTIN JOHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:JOHN
Last Name:BRAUN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10775 DOUBLE R BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8956
Mailing Address - Country:US
Mailing Address - Phone:775-247-5001
Mailing Address - Fax:
Practice Address - Street 1:10775 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8956
Practice Address - Country:US
Practice Address - Phone:775-247-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2014-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24004103TC0700X
NVPYT141125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical