MEDICARE: GALEN LEE BRUCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2017031119	MO

General Provider Information

NPI Number	:	1326736935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALEN LEE BRUCE

Provider Business Mailing Address
First Line	:	7020 WINONA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1970
Country	:	US
Telephone Number	:	314-489-0394
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 WINONA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1970
Country	:	US
Telephone Number	:	314-489-0394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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Directions to “ GALEN LEE BRUCE ” Practice Location

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