1679753198 NPI number — HELENE BEATRICE-LIA BRUNO LMFT

Table of content: HELENE BEATRICE-LIA BRUNO LMFT (NPI 1679753198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679753198 NPI number — HELENE BEATRICE-LIA BRUNO LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNO
Provider First Name:
HELENE
Provider Middle Name:
BEATRICE-LIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679753198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 5TH STREET #5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESENT CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-218-0535
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 5TH ST #5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-218-0535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 24749 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com