Provider Demographics
NPI:1912379199
Name:BRUCE PROFESSIONAL COUNSELING SERVICES
Entity Type:Organization
Organization Name:BRUCE PROFESSIONAL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:318-414-3065
Mailing Address - Street 1:824 ELMWOOD PARK BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3347
Mailing Address - Country:US
Mailing Address - Phone:504-733-0009
Mailing Address - Fax:504-733-0012
Practice Address - Street 1:824 ELMWOOD PARK BLVD STE 150
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3347
Practice Address - Country:US
Practice Address - Phone:504-733-0009
Practice Address - Fax:504-733-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health