Provider Demographics
NPI:1114218617
Name:BRUCE, CAROLYN ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2563
Mailing Address - Country:US
Mailing Address - Phone:318-345-7145
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST STE B-2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6955
Practice Address - Country:US
Practice Address - Phone:318-325-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional