Provider Demographics
NPI:1568504694
Name:BRUS, JEANNE D (BS)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:D
Last Name:BRUS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38483-7155
Mailing Address - Country:US
Mailing Address - Phone:931-629-9957
Mailing Address - Fax:
Practice Address - Street 1:115 DYER ST
Practice Address - Street 2:SUITE #1
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4551
Practice Address - Country:US
Practice Address - Phone:931-560-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN101YM0800XMedicaid