Provider Demographics
NPI:1891369633
Name:BRUCE, GILLIAN NICOLE
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:NICOLE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6133
Mailing Address - Country:US
Mailing Address - Phone:720-449-6676
Mailing Address - Fax:
Practice Address - Street 1:1233 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6133
Practice Address - Country:US
Practice Address - Phone:720-449-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO814442229Medicaid