Provider Demographics
NPI:1902003494
Name:LYNN A BRUNER
Entity Type:Organization
Organization Name:LYNN A BRUNER
Other - Org Name:SOUND HEART PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-748-1850
Mailing Address - Street 1:315 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1307
Mailing Address - Country:US
Mailing Address - Phone:570-748-1850
Mailing Address - Fax:
Practice Address - Street 1:315 N GROVE ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1307
Practice Address - Country:US
Practice Address - Phone:570-748-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS01528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092246Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST