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General NPI Number Information
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NPI Number | 1184338261
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Entity Type | Individual
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Provider Name | CHRISTOPHER J BRUCK LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 23051 KINGWOOD PLACE DR STE 110
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City | KINGWOOD
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State | TX
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Zip | 77339-3962
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Country | US
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Telephone | 844-824-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 COLONIAL SPRINGS LN
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City | SPRING
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State | TX
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Zip | 77386-2931
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Country | US
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Telephone | 817-880-9032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 65498
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License Number State | TX
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