Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC0008072 | PA |
N | 103K00000X | Behavior Analyst | BH000070 | PA |
NPI | 1013259191 |
---|---|
Provider Name | Tiffany Brunner |
First Address | Millersville, PA 17551-9781 |
Second Address | Millersville, PA 17551-1523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 26/02/2016 |