Provider Demographics
NPI:1932601648
Name:HOLIDAY-BRUNER, DAWN CHEREE (MFT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:CHEREE
Last Name:HOLIDAY-BRUNER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:CHEREE
Other - Last Name:BRUNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 JADE ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5304
Mailing Address - Country:US
Mailing Address - Phone:707-774-5811
Mailing Address - Fax:
Practice Address - Street 1:6965 REDWOOD BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945
Practice Address - Country:US
Practice Address - Phone:415-895-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist