Provider Demographics
NPI:1194947804
Name:BRUNET, JAMES D (MFT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:BRUNET
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3184
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-3184
Mailing Address - Country:US
Mailing Address - Phone:530-575-1176
Mailing Address - Fax:
Practice Address - Street 1:411 COYOTE ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2230
Practice Address - Country:US
Practice Address - Phone:530-575-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist