=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851563936
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINCENT BRUNO MA, LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2008
-----------------------------------------------------
Last Update Date | 11/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5540 N ACADEMY BLVD STE 210
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80918-3696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-330-3366
-----------------------------------------------------
Fax | 719-212-1671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19955 E TOP O THE MOOR DR
-----------------------------------------------------
City | MONUMENT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80132-9313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-453-5780
-----------------------------------------------------
Fax | 719-635-9946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------