Provider Demographics
NPI:1609762020
Name:BRUNELLE, NAOMI GENEVIE (BS)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:GENEVIE
Last Name:BRUNELLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 W 9000 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5729
Mailing Address - Country:US
Mailing Address - Phone:949-510-0257
Mailing Address - Fax:
Practice Address - Street 1:986 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5729
Practice Address - Country:US
Practice Address - Phone:949-510-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician