Provider Demographics
NPI:1518112127
Name:DIMICK, BRUCE E (LCMFT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:DIMICK
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W IRON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2600
Mailing Address - Country:US
Mailing Address - Phone:785-342-0021
Mailing Address - Fax:
Practice Address - Street 1:119 W. IRON
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-342-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT, 809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health