Individual provider · NPI-1

Geoffrey Kevin Bruno Sr.

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities · Katy, TX

NPI number1982140745

StatusActive

Last updated in NPPESAug 18, 2020

Details

NPI: 1982140745
Entity type: Individual (NPI-1)
Name: Mr. Geoffrey Kevin Bruno Sr.
Sex: Male
Sole proprietor: Yes
Enumeration date: Jan 17, 2017
Certification date: Aug 18, 2020
Last updated: Aug 18, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	–	–	Yes
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–
106E00000X	Assistant Behavior Analyst	–	–
101YP1600X	Counselor, Pastoral	–	–
103TC2200X	Psychologist, Clinical Child & Adolescent	–	–
104100000X	Social Worker	–	–
1041S0200X	Social Worker, School	–	–
171W00000X	Contractor	–	–
225C00000X	Rehabilitation Counselor	–	–
320800000X	Community Based Residential Treatment Facility, Mental Illness	–	–
322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	–	–

Practice location

21203 Park Valley Dr
Katy, TX 77450-4820

Phone 210-563-0768

Mailing address

21203 Park Valley Dr
Katy, TX 77450-4820

Phone 210-563-0768

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