Provider Demographics
NPI:1821127234
Name:BRUCE, SHANE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:
Last Name:BRUCE
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 1:30 W MISSION ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-0401
Mailing Address - Country:US
Mailing Address - Phone:323-285-0180
Mailing Address - Fax:
Practice Address - Street 1:1480 SANTA YNEZ AVE
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-1311
Practice Address - Country:US
Practice Address - Phone:323-610-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist