Healthcare Provider Details

I. General information

NPI: 1548771629
Provider Name (Legal Business Name): ALICIA BRUZEK LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA MEANS TLMHC

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date: 09/07/2018
Reactivation Date: 09/12/2018

III. Provider practice location address

600 3RD ST SE STE 104
CEDAR RAPIDS IA
52401-2029
US

IV. Provider business mailing address

600 3RD ST SE STE 104
CEDAR RAPIDS IA
52401-2029
US

V. Phone/Fax

Practice location:
  • Phone: 319-558-6855
  • Fax:
Mailing address:
  • Phone: 319-558-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number091963
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: