Healthcare Provider Details

I. General information

NPI: 1437228467
Provider Name (Legal Business Name): BETTY JEAN BRUNE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 BRIGGS ST SUITE 700
SAN ANTONIO TX
78224-1221
US

IV. Provider business mailing address

94 BRIGGS ST SUITE 700
SAN ANTONIO TX
78224-1221
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-3556
  • Fax: 210-924-3557
Mailing address:
  • Phone: 210-924-3556
  • Fax: 210-924-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6627
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number25235
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: