Provider Demographics
NPI:1295159341
Name:BRUNET, TRACI (MS)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:BRUNET
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:528 TERRACEVIEW CV APT 212
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1756
Mailing Address - Country:US
Mailing Address - Phone:352-870-9476
Mailing Address - Fax:
Practice Address - Street 1:2500 MAITLAND CENTER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4174
Practice Address - Country:US
Practice Address - Phone:407-789-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3661106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health