Provider Demographics
NPI:1811483944
Name:BRUCE, KATY ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:ELIZABETH
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S AUSTIN AVE STE 110-418
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6700
Mailing Address - Country:US
Mailing Address - Phone:325-665-7950
Mailing Address - Fax:
Practice Address - Street 1:1006 S ROCK ST # 102
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5837
Practice Address - Country:US
Practice Address - Phone:325-665-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553831041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty