Provider Demographics
NPI:1336325893
Name:BRUCE, J KWAME (MS, LPC, LSOTP)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:KWAME
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MS, LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 NOTTINGHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7345
Mailing Address - Country:US
Mailing Address - Phone:512-246-9664
Mailing Address - Fax:512-246-9664
Practice Address - Street 1:1110 NOTTINGHAM HILL RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7345
Practice Address - Country:US
Practice Address - Phone:512-246-9664
Practice Address - Fax:512-246-9664
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional