Healthcare Provider Details

I. General information

NPI: 1295159341
Provider Name (Legal Business Name): TRACI BRUNET M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACI COX

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MAITLAND CENTER PKWY STE 250
MAITLAND FL
32751-4174
US

IV. Provider business mailing address

528 TERRACEVIEW CV APT 212
ALTAMONTE SPRINGS FL
32714-1756
US

V. Phone/Fax

Practice location:
  • Phone: 407-789-0500
  • Fax:
Mailing address:
  • Phone: 352-870-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMT3661
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: