Provider Demographics
NPI:1851563936
Name:BRUNO, VINCENT (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:BRUNO
Suffix:
Gender:M
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 1:19955 E TOP O THE MOOR DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9313
Mailing Address - Country:US
Mailing Address - Phone:719-453-5780
Mailing Address - Fax:719-635-9946
Practice Address - Street 1:5540 N ACADEMY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3696
Practice Address - Country:US
Practice Address - Phone:719-330-3366
Practice Address - Fax:719-212-1671
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98000150866Medicaid