Basic Information
| Provider Information | |||||||||
| NPI: | 1801272844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUNS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | KAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5098 FOOTHILLS BLVD | ||||||||
| Address2: | SUITE 3 #149 | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957476526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169053542 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8421 AUBURN BLVD | ||||||||
| Address2: | BLDG. # 3 | ||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956100359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167226100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2015 | ||||||||
| LastUpdateDate: | 12/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.