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General NPI Number Information
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NPI Number | 1720294614
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Entity Type | Individual
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Provider Name | GARY ROBERT BRULAND D.MIN.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1200 CAMP HILL BYP STE 205
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City | CAMP HILL
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State | PA
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Zip | 17011-3700
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Country | US
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Telephone | 717-364-5619
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Fax |
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Provider Business Mailing Address
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Address Line | 5239 DEERFIELD AVE
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City | MECHANICSBURG
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State | PA
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Zip | 17050-6839
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Country | US
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Telephone | 717-730-3704
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401005427
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC002299
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.0005486
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License Number State | OH
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