Doctor Name: | MR. JAMES GLEN BRUNSON |
NPI Number: | 1760764047 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 800 Dollins St Wilburton, OK - 745783204 |
Business Phone Number: | 9184485497 |
Business Fax Number: | |
Mailing Address: | 800 Dollins St, WILBURTON |
State: | OK |
Postal Code: | 745783204 |
Phone Number: | 9184485497 |
Fax Number: | |
NPI Enumeration Date: | 09/13/2011 |
NPI Last Update Date: | 09/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |