Provider Demographics
NPI:1275662991
Name:CASEY, BRUCE DOUGLAS (PH D)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DOUGLAS
Last Name:CASEY
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5277 MANHATTAN CIR
Mailing Address - Street 2:SUITE110
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-8201
Mailing Address - Country:US
Mailing Address - Phone:303-543-5783
Mailing Address - Fax:303-543-5782
Practice Address - Street 1:5277 MANHATTAN CIR
Practice Address - Street 2:SUITE110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-8201
Practice Address - Country:US
Practice Address - Phone:303-543-5783
Practice Address - Fax:303-543-5782
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical