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General NPI Number Information
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NPI Number | 1417120908
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Entity Type | Organization
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Legal Business Name | LYNDA S. BRUCE
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 350 E ST STE. 209
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City | EUREKA
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State | CA
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Zip | 95501-0357
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Country | US
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Telephone | 707-476-0272
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Fax | 707-442-2820
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Provider Business Mailing Address
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Address Line | 1710 BUHNE ST
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City | EUREKA
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State | CA
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Zip | 95501-3102
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Country | US
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Telephone | 707-476-0272
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Fax | 707-442-2820
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LYNDA S. BRUCE
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Credential | PH.D.
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Telephone | 707-476-0272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY18948
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License Number State | CA
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