Provider Demographics
NPI:1942552054
Name:BRUCE, WILLIAM JAY (LCPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAY
Last Name:BRUCE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S 1ST AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1398
Mailing Address - Country:US
Mailing Address - Phone:208-550-8861
Mailing Address - Fax:208-263-1796
Practice Address - Street 1:102 S 1ST AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1398
Practice Address - Country:US
Practice Address - Phone:208-550-8861
Practice Address - Fax:208-263-1796
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1942552054Medicaid