Healthcare Provider Details

I. General information

NPI: 1417042995
Provider Name (Legal Business Name): LYNDA S BRUCE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 BUHNE ST
EUREKA CA
95501-3102
US

IV. Provider business mailing address

350 E ST SUITE 209
EUREKA CA
95501-0357
US

V. Phone/Fax

Practice location:
  • Phone: 707-444-8805
  • Fax: 707-442-2820
Mailing address:
  • Phone: 707-476-0272
  • Fax: 707-442-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: