Provider Demographics
NPI:1114454949
Name:TROXEL, BRUCE (CAS, NCACII)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:TROXEL
Suffix:
Gender:M
Credentials:CAS, NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 MELTON RD
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-3114
Mailing Address - Country:US
Mailing Address - Phone:219-938-4651
Mailing Address - Fax:219-938-4679
Practice Address - Street 1:8000 MELTON RD
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-3114
Practice Address - Country:US
Practice Address - Phone:219-938-4651
Practice Address - Fax:219-938-4679
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNC-4607101YA0400X
VA016170101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)