Healthcare Provider Details

I. General information

NPI: 1437073855
Provider Name (Legal Business Name): JUDY ANN BRUCE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 HYACINTH LN
PEACHTREE CITY GA
30269-3957
US

IV. Provider business mailing address

1113 HYACINTH LN
PEACHTREE CITY GA
30269-3957
US

V. Phone/Fax

Practice location:
  • Phone: 720-254-3992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number011395
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: