Provider Demographics
NPI:1841347275
Name:EDDINS, BRUCE ANTHONY (MA)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ANTHONY
Last Name:EDDINS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 E FLAMINGO RD STE B22
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5120
Mailing Address - Country:US
Mailing Address - Phone:702-489-2889
Mailing Address - Fax:702-780-0755
Practice Address - Street 1:1670 E FLAMINGO RD STE B22
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5120
Practice Address - Country:US
Practice Address - Phone:702-489-2889
Practice Address - Fax:702-780-0755
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 251B00000X, 251S00000X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health