Provider Demographics
NPI:1942514765
Name:BRUCE, AMANDA SCHURLE (PHD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SCHURLE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHERISE
Other - Last Name:SCHURLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5030 CHERRY ST
Mailing Address - Street 2:#307
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-2232
Mailing Address - Country:US
Mailing Address - Phone:816-235-6101
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2937
Practice Address - Country:US
Practice Address - Phone:913-588-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical