Provider Demographics
NPI:1114575131
Name:BRIGGS, BRUCE GORDON (LMHC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:GORDON
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10142 BROOKS SCHOOL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-3839
Mailing Address - Country:US
Mailing Address - Phone:317-648-0832
Mailing Address - Fax:
Practice Address - Street 1:10142 BROOKS SCHOOL RD STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-3839
Practice Address - Country:US
Practice Address - Phone:317-648-0832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003521A101YM0800X
IN35002093A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health