Provider Demographics
NPI:1417042995
Name:BRUCE, LYNDA S (PHD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:S
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0357
Mailing Address - Country:US
Mailing Address - Phone:707-476-0272
Mailing Address - Fax:707-442-2820
Practice Address - Street 1:1710 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3102
Practice Address - Country:US
Practice Address - Phone:707-444-8805
Practice Address - Fax:707-442-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical