Provider Demographics
NPI:1639464787
Name:BRUN, MARY KATHRYNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHRYNE
Last Name:BRUN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYNE
Other - Last Name:BODDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:247 TEAL LN
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75645-6894
Mailing Address - Country:US
Mailing Address - Phone:903-240-4344
Mailing Address - Fax:903-295-5858
Practice Address - Street 1:3118 H G MOSLEY PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2941
Practice Address - Country:US
Practice Address - Phone:903-002-1433
Practice Address - Fax:903-295-5858
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional