Provider Demographics
NPI:1659517837
Name:BRUNNER, PAUL MICHAEL (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL
Last Name:BRUNNER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 RUGBY MINES RD
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-9756
Mailing Address - Country:US
Mailing Address - Phone:910-574-3515
Mailing Address - Fax:
Practice Address - Street 1:538 RUGBY MINES RD
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-9756
Practice Address - Country:US
Practice Address - Phone:910-574-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP004680101YA0400X
NCP-00046801041C0700X
NCC 0070621041C0700X
NCC007062104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical