Provider Demographics
NPI:1821766965
Name:BRUNER, SHELLY RENE (LLPC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RENE
Last Name:BRUNER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14879 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:CEMENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49233-9641
Mailing Address - Country:US
Mailing Address - Phone:517-206-3350
Mailing Address - Fax:
Practice Address - Street 1:636 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1628
Practice Address - Country:US
Practice Address - Phone:734-664-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451014627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health