Provider Demographics
NPI:1134794183
Name:BRUNER, COLBY (LMFT)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:BRUNER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11670 WEDD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3215
Mailing Address - Country:US
Mailing Address - Phone:316-227-7070
Mailing Address - Fax:
Practice Address - Street 1:11670 WEDD ST APT 2
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-3215
Practice Address - Country:US
Practice Address - Phone:316-227-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03212-T106H00000X
KS03323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist