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General NPI Number Information
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NPI Number | 1295905479
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Entity Type | Individual
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Provider Name | TROY LAWN BRUNER ED.D
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Gender | Male
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 850 MAPLE STREET
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-0800
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Country | US
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Telephone | 509-565-4000
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Fax | 509-565-4705
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Provider Business Mailing Address
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Address Line | 322 W NORTH RIVER DR RIVERFRONT MEDICAL CENTER
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City | SPOKANE
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State | WA
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Zip | 99201
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Country | US
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Telephone | 509-324-6464
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Fax | 509-241-2056
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY60115733
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60115733
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-202879
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License Number State | ID
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