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General NPI Number Information
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NPI Number | 1164942686
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Entity Type | Organization
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Legal Business Name | MIND/MOOD COUNSELING & COACHING CENTERS OF SWFL, PLLC
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 9990 COCONUT ROAD ATTN. EMILY - BES MANAGER
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City | BONITA SPRINGS
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State | FL
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Zip | 34135
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Country | US
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Telephone | 239-770-7267
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Fax |
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Provider Business Mailing Address
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Address Line | 10970 S. CLEVELAND AVE. #303 BRUNO AND PRADO, PLLC (ATTN: KATHY BRUNO)
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City | FORT MYERS
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State | FL
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Zip | 33919
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Country | US
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Telephone | 239-770-7267
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Fax |
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Authorized Official
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Title or Position | CEO / MANAGER/MEMBER
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Name | DR. REGINALD MYRON BRUNO
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Credential | LCSW, MCAP
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Telephone | 239-770-7267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW9243
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License Number State | FL
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