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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | |
No | 101YP1600X | Behavioral Health & Social Service Providers | Counselor | Pastoral |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
No | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School |
No | 171W00000X | Other Service Providers | Contractor | |
No | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |