Provider Demographics
NPI:1922523281
Name:BRUNER, KATHERINE B (LCMHC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:B
Last Name:BRUNER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9798 N 6530 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9247
Mailing Address - Country:US
Mailing Address - Phone:801-636-3036
Mailing Address - Fax:
Practice Address - Street 1:222 W 540 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6631
Practice Address - Country:US
Practice Address - Phone:801-404-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275727-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health