Provider Demographics
NPI:1700981321
Name:BRUCKEN, BARBARA A (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BRUCKEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5928
Mailing Address - Country:US
Mailing Address - Phone:432-570-9552
Mailing Address - Fax:432-570-9859
Practice Address - Street 1:2104 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5928
Practice Address - Country:US
Practice Address - Phone:432-570-9552
Practice Address - Fax:432-570-9859
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-3031103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000594E7Medicaid
TXR01395Medicare UPIN
TX00594EMedicare ID - Type Unspecified