Provider Demographics
NPI:1750325759
Name:BARDWELL, BRUCE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:BARDWELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 TASMAN PL
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-4016
Mailing Address - Country:US
Mailing Address - Phone:360-678-4368
Mailing Address - Fax:
Practice Address - Street 1:105 NW 1ST STREET
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239
Practice Address - Country:US
Practice Address - Phone:360-682-4038
Practice Address - Fax:360-678-3636
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist