Provider Demographics
NPI:1912575697
Name:BRUSCOE, AMY K (LMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:BRUSCOE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 W RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9333
Mailing Address - Country:US
Mailing Address - Phone:509-868-8287
Mailing Address - Fax:
Practice Address - Street 1:422 W RIVERSIDE AVE STE 518
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0302
Practice Address - Country:US
Practice Address - Phone:509-474-1976
Practice Address - Fax:888-741-7039
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61174373101YM0800X
WILH61174373101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health