Provider Demographics
NPI:1982140745
Name:BRUNO, GEOFFREY KEVIN SR
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:KEVIN
Last Name:BRUNO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21203 PARK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4820
Mailing Address - Country:US
Mailing Address - Phone:210-563-0768
Mailing Address - Fax:
Practice Address - Street 1:21203 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-4820
Practice Address - Country:US
Practice Address - Phone:210-563-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171W00000XOther Service ProvidersContractor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children