Provider Demographics
NPI:1720294614
Name:BRULAND, GARY ROBERT (DMIN)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROBERT
Last Name:BRULAND
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5239 DEERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-6839
Mailing Address - Country:US
Mailing Address - Phone:717-730-3704
Mailing Address - Fax:
Practice Address - Street 1:1200 CAMP HILL BYP STE 205
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-3700
Practice Address - Country:US
Practice Address - Phone:717-364-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005427101YP2500X
PAPC002299101YP2500X
OHC.0005486101YP2500X
MI4101006082106H00000X
NY000820106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist