Basic Information
| Provider Information | |||||||||
| NPI: | 1235379447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUFSON | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9925 GARAMOUND AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891175990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028608316 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2965 S JONES BLVD STE D | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027338098 | ||||||||
| FaxNumber: | 7023956457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2009 | ||||||||
| LastUpdateDate: | 12/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3027-C | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.