Healthcare Provider Details

I. General information

NPI: 1679421002
Provider Name (Legal Business Name): ELIZABETH LIVINGSTON BRUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 REGAL CIRCLE
BLUE RIVER CO
80424
US

IV. Provider business mailing address

PO BOX 2864
BRECKENRIDGE CO
80424-2852
US

V. Phone/Fax

Practice location:
  • Phone: 720-727-1708
  • Fax:
Mailing address:
  • Phone: 720-727-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0023474
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: