Provider Demographics
NPI:1851953590
Name:BRUCE J. BOSWELL, LPC, PC
Entity Type:Organization
Organization Name:BRUCE J. BOSWELL, LPC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-806-2600
Mailing Address - Street 1:PO BOX 271416
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1416
Mailing Address - Country:US
Mailing Address - Phone:361-806-2600
Mailing Address - Fax:361-806-2624
Practice Address - Street 1:4925 EVERHART RD STE 103
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3912
Practice Address - Country:US
Practice Address - Phone:361-806-2600
Practice Address - Fax:361-806-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty