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Individual

JONATHAN BRUNK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1621 SUTTER PLACE, CLOVIS, NM 88101
(575) 935-2345
(575) 742-3182
Mailing address
1100 W. 21ST, CLOVIS, NM 88101
(575) 769-2345
(575) 769-9013

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0167251
NM
101Y00000X
Counselor

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0167251
LICENSED MENTAL HEALTH COUNSELOR
NM
Enumeration date
12/18/2012
Last updated
03/17/2015
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