Provider Demographics
NPI:1912203266
Name:BRUNER, TINA M (MHR)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:BRUNER
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-6256
Mailing Address - Country:US
Mailing Address - Phone:405-232-1401
Mailing Address - Fax:405-232-1402
Practice Address - Street 1:628 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-6256
Practice Address - Country:US
Practice Address - Phone:405-232-1401
Practice Address - Fax:405-232-1402
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)