MEDICARE: BRUCE ANTHONY EDDINS MA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	CA

General Provider Information

NPI Number	:	1841347275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE ANTHONY EDDINS MA

Provider Business Mailing Address
First Line	:	1670 E FLAMINGO RD STE B22
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5120
Country	:	US
Telephone Number	:	702-489-2889
Fax Number	:	702-780-0755

Provider Business Practice Location Address
First Line	:	1670 E FLAMINGO RD STE B22
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5120
Country	:	US
Telephone Number	:	702-489-2889
Fax Number	:	702-780-0755

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	02/15/2024

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