=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619687845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINE BRUNER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2022
-----------------------------------------------------
Last Update Date | 11/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1211 N SHARTEL AVE STE 602
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73103-2445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-819-6760
-----------------------------------------------------
Fax | 405-493-9646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1211 N SHARTEL AVE STE 602
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73103-2445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-819-6760
-----------------------------------------------------
Fax | 405-493-9646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMFT & OWNER
-----------------------------------------------------
Name | CHRISTINE J BRUNER
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 405-819-6760
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------