Provider Demographics
NPI:1639676158
Name:DE BRUIN, CHRIS (LPC)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:DE BRUIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GRAND JUNCTION METRO TREATMENT CENTER
Mailing Address - Street 2:1001 WELLINGTON AVE
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-208-1130
Mailing Address - Fax:970-208-1132
Practice Address - Street 1:GRAND JUNCTION METRO TREATMENT CENTER
Practice Address - Street 2:1001 WELLINGTON AVE
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-208-1130
Practice Address - Fax:970-208-1132
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO617101YP2500X
CO3394101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional