Healthcare Provider Details

I. General information

NPI: 1174146195
Provider Name (Legal Business Name): KYLE W BRUCKE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 AL HIGHWAY 157 STE B
CULLMAN AL
35058-0672
US

IV. Provider business mailing address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

V. Phone/Fax

Practice location:
  • Phone: 256-701-5651
  • Fax: 256-429-9411
Mailing address:
  • Phone: 256-288-3333
  • Fax: 256-288-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4294C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: