MEDICARE: DR. BRUCE MANSBRIDGE PH.D.

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	103T00000X	Psychologist	31754	TX

General Provider Information

NPI Number	:	1386729911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE MANSBRIDGE PH.D.

Provider Business Mailing Address
First Line	:	6633 E HWY 290
Second Line	:	SUITE 300
City	:	AUSTIN
State	:	TX
Zip	:	78723-1158
Country	:	US
Telephone Number	:	512-327-9494
Fax Number	:	512-637-5578

Provider Business Practice Location Address
First Line	:	6633 E HWY 290
Second Line	:	SUITE 300
City	:	AUSTIN
State	:	TX
Zip	:	78723-1172
Country	:	US
Telephone Number	:	512-327-9494
Fax Number	:	512-637-5578

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	11/10/2009

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