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NPI Code Detail

MEDICARE: MISS SELENA LORRAINE BRUNSON

MEDICARE:  MISS SELENA LORRAINE BRUNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1821388711
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SELENA LORRAINE BRUNSON
Provider Business Mailing Address
First Line : 7059 SAN MIGUEL AVE
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-2102
Country : US
Telephone Number : 619-589-8296
Fax Number : 619-461-4518
Provider Business Practice Location Address
First Line : 7059 SAN MIGUEL AVE
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-2102
Country : US
Telephone Number : 619-589-8296
Fax Number : 619-461-4518
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2011
Last Update Date : 04/12/2011

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Directions to “ MISS SELENA LORRAINE BRUNSON ” Practice Location

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