=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790622702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE HUYSER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2026
-----------------------------------------------------
Last Update Date | 04/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2105 POTTER COVE LN
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28104-7294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-230-3529
-----------------------------------------------------
Fax | 509-246-6276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2105 POTTER COVE LN
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28104-7294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-230-3529
-----------------------------------------------------
Fax | 509-246-6276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | BRUCE ALAN HUYSER
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 509-230-3529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------