Provider Demographics
NPI:1821284852
Name:BRUNNING, VINCE CHARLES (MA (OXON), MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:VINCE
Middle Name:CHARLES
Last Name:BRUNNING
Suffix:
Gender:M
Credentials:MA (OXON), MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-4598
Mailing Address - Country:US
Mailing Address - Phone:541-966-7770
Mailing Address - Fax:541-966-7799
Practice Address - Street 1:622 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-4598
Practice Address - Country:US
Practice Address - Phone:541-966-7770
Practice Address - Fax:541-966-7799
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC1086OtherLPC