Healthcare Provider Details

I. General information

NPI: 1467376475
Provider Name (Legal Business Name): BROOKE RAECHELLE BUGNI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 CORACI BLVD APT 5112
PORT ORANGE FL
32128-7575
US

IV. Provider business mailing address

5400 CORACI BLVD APT 5112
PORT ORANGE FL
32128-7575
US

V. Phone/Fax

Practice location:
  • Phone: 609-402-1100
  • Fax:
Mailing address:
  • Phone: 609-402-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: