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General NPI Number Information
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NPI Number | 1932235934
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Entity Type | Individual
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Provider Name | SHANE BRUNE LPC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 1209 EBBTIDE CV
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City | BRYAN
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State | TX
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Zip | 77845-8814
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Country | US
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Telephone | 979-220-8625
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 EBBTIDE CV
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8814
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Country | US
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Telephone | 979-220-8625
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19890
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License Number State | TX
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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 | 19890
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License Number State | TX
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