Provider Demographics
NPI:1134384332
Name:BRUCE, SALLY K (LMHC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:K
Last Name:BRUCE
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 1:3812 W LINEBAUGH AVE
Mailing Address - Street 2:STE. 107
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8702
Mailing Address - Country:US
Mailing Address - Phone:813-546-4534
Mailing Address - Fax:813-333-5243
Practice Address - Street 1:3812 W LINEBAUGH AVE
Practice Address - Street 2:STE. 107
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8702
Practice Address - Country:US
Practice Address - Phone:813-546-4534
Practice Address - Fax:813-333-5243
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health