Healthcare Provider Details

I. General information

NPI: 1922523281
Provider Name (Legal Business Name): KATHERINE B BRUNER LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 540 N
OREM UT
84057-6631
US

IV. Provider business mailing address

9798 N 6530 W
HIGHLAND UT
84003-9247
US

V. Phone/Fax

Practice location:
  • Phone: 801-404-0064
  • Fax:
Mailing address:
  • Phone: 801-636-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number275727-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: