Basic Information
| Provider Information | |||||||||
| NPI: | 1457605271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUNS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MA, QMHP, CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1170 PEARL ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417434340 | ||||||||
| FaxNumber: | 8889750250 | ||||||||
| Practice Location | |||||||||
| Address1: | 1170 PEARL ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417434340 | ||||||||
| FaxNumber: | 5417434369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2012 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | T-19-102 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 500662981 | 05 | OR | MEDICAID | 500759744 | 05 | OR | MEDICAID |