Provider Demographics
NPI:1548771629
Name:BRUZEK, ALICIA (LMHC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BRUZEK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:MEANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TLMHC
Mailing Address - Street 1:600 3RD ST SE STE 104
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2029
Mailing Address - Country:US
Mailing Address - Phone:319-558-6855
Mailing Address - Fax:
Practice Address - Street 1:600 3RD ST SE STE 104
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2029
Practice Address - Country:US
Practice Address - Phone:319-558-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2023-08-08
Deactivation Date:2018-09-07
Deactivation Code:
Reactivation Date:2018-09-12
Provider Licenses
StateLicense IDTaxonomies
IA091963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health