Provider Demographics
NPI:1134424187
Name:BRUEN, STACEY (MC, NCC, LPC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BRUEN
Suffix:
Gender:F
Credentials:MC, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9929 N 95TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4592
Mailing Address - Country:US
Mailing Address - Phone:480-948-1123
Mailing Address - Fax:
Practice Address - Street 1:9929 N 95TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4592
Practice Address - Country:US
Practice Address - Phone:480-948-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCC63702101YM0800X
AZ10342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health