Provider Demographics
NPI:1073031563
Name:BRUCE, JODI KAYE (LMFT 108601)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:KAYE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LMFT 108601
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5455 GARDEN GROVE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8201
Mailing Address - Country:US
Mailing Address - Phone:310-745-7351
Mailing Address - Fax:
Practice Address - Street 1:5455 GARDEN GROVE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-8201
Practice Address - Country:US
Practice Address - Phone:310-745-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108601106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86437OtherBOARD OF BEHAVIORAL SCIENCES