Provider Demographics
NPI:1508849704
Name:BRUCE, DEBRA ANN (MS, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 WEST LOOP S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4103
Mailing Address - Country:US
Mailing Address - Phone:713-668-4445
Mailing Address - Fax:713-668-4443
Practice Address - Street 1:6750 WEST LOOP S
Practice Address - Street 2:SUITE 220
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4103
Practice Address - Country:US
Practice Address - Phone:713-668-4445
Practice Address - Fax:713-668-4443
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11924101Y00000X, 101YM0800X, 101YP2500X, 103TC1900X, 103T00000X
TX2906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0012921Medicaid
TX2575LCOtherBLUE CROSS-BLUE SHIELD #