MEDICARE: MR. PATRICK (RICK) C. R. BRUNK M.ED.

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
1	101YM0800X	Mental Health Counselor	LH5347	WA
2	101YP2500X	Professional Counselor	1203	OR

General Provider Information

NPI Number	:	1841396199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK (RICK) C. R. BRUNK M.ED.

Provider Business Mailing Address
First Line	:	1030 N CENTER PKWY
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7160
Country	:	US
Telephone Number	:	509-735-3132
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 N CENTER PKWY
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7160
Country	:	US
Telephone Number	:	509-735-3132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	03/01/2013

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