Provider Demographics
NPI:1649316050
Name:BRUNNER, JOHN FLOYD (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FLOYD
Last Name:BRUNNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:FLOYD
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:30400 DETROIT RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1872
Mailing Address - Country:US
Mailing Address - Phone:440-617-9222
Mailing Address - Fax:440-617-9222
Practice Address - Street 1:30400 DETROIT RD
Practice Address - Street 2:SUITE 211
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1872
Practice Address - Country:US
Practice Address - Phone:440-617-9222
Practice Address - Fax:440-617-9222
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist