Provider Demographics
NPI:1972783611
Name:JAMES BRUNER, CARLEY JEAN (MA,)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:JEAN
Last Name:JAMES BRUNER
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:CARLEY
Other - Middle Name:
Other - Last Name:JAMES BRUNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARTINEZ & HUEBNER
Mailing Address - Street 1:PO BOX 4145
Mailing Address - Street 2:
Mailing Address - City:SOUTH COLBY
Mailing Address - State:WA
Mailing Address - Zip Code:98384-0145
Mailing Address - Country:US
Mailing Address - Phone:253-691-6762
Mailing Address - Fax:
Practice Address - Street 1:2715 GARFIELD AVE SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-8714
Practice Address - Country:US
Practice Address - Phone:253-691-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00055624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional