Provider Demographics
NPI:1427795657
Name:BRUNT, RANDI
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:BRUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23403 E MISSION AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7624
Mailing Address - Country:US
Mailing Address - Phone:509-903-5226
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST STE 665
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2212
Practice Address - Country:US
Practice Address - Phone:509-903-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WAMC61314808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health