Healthcare Provider Details

I. General information

NPI: 1114218617
Provider Name (Legal Business Name): CAROLYN ANN BRUCE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST STE B-2
MONROE LA
71201-6955
US

IV. Provider business mailing address

41 W ELMWOOD DR
MONROE LA
71203-2563
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8782
  • Fax:
Mailing address:
  • Phone: 318-345-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3935
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: