Provider Demographics
NPI:1922492321
Name:BRUNO COUNSELING AND CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:BRUNO COUNSELING AND CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-746-5125
Mailing Address - Street 1:110 W ERLANGER ST
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-3009
Mailing Address - Country:US
Mailing Address - Phone:601-746-5125
Mailing Address - Fax:844-348-9002
Practice Address - Street 1:110 W ERLANGER ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-3009
Practice Address - Country:US
Practice Address - Phone:601-746-5125
Practice Address - Fax:844-348-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC81791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05239528Medicaid