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General NPI Number Information
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NPI Number | 1487633244
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Entity Type | Individual
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Provider Name | THOMAS MICHAEL BRUNNER PH.D., M.A.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6614 E CARONDELET DR
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City | TUCSON
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State | AZ
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Zip | 85710-2119
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Country | US
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Telephone | 520-296-8572
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Fax |
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Provider Business Mailing Address
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Address Line | 11720 E TWIN HILLS TRL
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City | TUCSON
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State | AZ
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Zip | 85748-7934
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Country | US
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Telephone | 520-260-0068
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3717
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License Number State | AZ
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