Provider Demographics
NPI:1952389439
Name:BRUESKE, LYNN EDNA (EDS, LMHC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:EDNA
Last Name:BRUESKE
Suffix:
Gender:F
Credentials:EDS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810-1 WILLIAMSBURG PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-9220
Mailing Address - Country:US
Mailing Address - Phone:904-733-9669
Mailing Address - Fax:904-733-4194
Practice Address - Street 1:3810-1 WILLIAMSBURG PARK BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-9220
Practice Address - Country:US
Practice Address - Phone:904-733-9669
Practice Address - Fax:904-733-4194
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health