Provider Demographics
NPI:1982719118
Name:BRUNETTI CONSULTING, INC
Entity type:Organization
Organization Name:BRUNETTI CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-428-4060
Mailing Address - Street 1:21308 JOHN MILLESS DR
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4708
Mailing Address - Country:US
Mailing Address - Phone:763-428-4060
Mailing Address - Fax:763-428-1711
Practice Address - Street 1:21308 JOHN MILLESS DR
Practice Address - Street 2:SUITE 101B
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4708
Practice Address - Country:US
Practice Address - Phone:763-428-4060
Practice Address - Fax:763-428-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4169103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6120399OtherUNITED BEHAVIORAL HEALTH
MN138221OtherBHP
MN88G92BROtherBLUE CROSS
MN719220700Medicaid
MNC04256Medicare UPIN