Provider Demographics
NPI:1235283052
Name:CHRISTLE, BRUCE W (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:CHRISTLE
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MILAGRO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2882
Mailing Address - Country:US
Mailing Address - Phone:949-766-8082
Mailing Address - Fax:949-766-8082
Practice Address - Street 1:2 MILAGRO
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2882
Practice Address - Country:US
Practice Address - Phone:949-766-8082
Practice Address - Fax:949-766-8082
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 16786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist