Provider Demographics
NPI:1972284909
Name:BRUTON, KHALILAH (MA, NCC)
Entity type:Individual
Prefix:
First Name:KHALILAH
Middle Name:
Last Name:BRUTON
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 W 144TH PL STE 304
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2564
Mailing Address - Country:US
Mailing Address - Phone:650-560-4381
Mailing Address - Fax:
Practice Address - Street 1:9501 W 144TH PL STE 304
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2564
Practice Address - Country:US
Practice Address - Phone:708-628-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health