Provider Demographics
NPI:1144480575
Name:BRUNO, MARLON VINCENTE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:MARLON
Middle Name:VINCENTE
Last Name:BRUNO
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 FLYNN PKWY STE 114
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4318
Mailing Address - Country:US
Mailing Address - Phone:361-884-7600
Mailing Address - Fax:361-884-7677
Practice Address - Street 1:5151 FLYNN PKWY STE 114
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4318
Practice Address - Country:US
Practice Address - Phone:361-884-7600
Practice Address - Fax:361-884-7677
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health