Provider Demographics
NPI:1275065021
Name:BRUCE, PAUL (LICDC-CS, LPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:BRUCE
Suffix:
Gender:M
Credentials:LICDC-CS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 PRIVATE ROAD 2913
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-8652
Mailing Address - Country:US
Mailing Address - Phone:740-479-2839
Mailing Address - Fax:
Practice Address - Street 1:841 PRIVATE ROAD 2913
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659-8652
Practice Address - Country:US
Practice Address - Phone:740-479-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121042101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)