Provider Demographics
NPI:1962033605
Name:BRUNO, CHELCI MARIE
Entity Type:Individual
Prefix:
First Name:CHELCI
Middle Name:MARIE
Last Name:BRUNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 1/2 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2325
Mailing Address - Country:US
Mailing Address - Phone:406-360-1047
Mailing Address - Fax:
Practice Address - Street 1:2423 MULLAN RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1827
Practice Address - Country:US
Practice Address - Phone:406-360-1047
Practice Address - Fax:406-830-3156
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-42582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health