Basic Information
| Provider Information | |||||||||
| NPI: | 1114218617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUCE | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 W ELMWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712032563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183457145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 WASHINGTON ST STE B-2 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712016955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183258782 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2011 | ||||||||
| LastUpdateDate: | 05/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3935 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.