Provider Demographics
NPI:1962951962
Name:BRULAY, KIM (LMHC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:BRULAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 OTTER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-6726
Mailing Address - Country:US
Mailing Address - Phone:863-899-9069
Mailing Address - Fax:863-648-9749
Practice Address - Street 1:1543 LAKELAND HILLS BLVD STE 7
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3246
Practice Address - Country:US
Practice Address - Phone:863-899-9069
Practice Address - Fax:863-648-9749
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty