Provider Demographics
NPI:1457383440
Name:HUST, BRUCE EDWARD (PHD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:EDWARD
Last Name:HUST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711
Mailing Address - Country:US
Mailing Address - Phone:812-422-7974
Mailing Address - Fax:812-422-8163
Practice Address - Street 1:2015 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711
Practice Address - Country:US
Practice Address - Phone:812-422-7974
Practice Address - Fax:812-422-8163
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040619A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100243050BMedicaid
IN100243050BMedicaid