MEDICARE: DR. BRUCE ALLEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3777	AZ

General Provider Information

NPI Number	:	1346258456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ALLEN PH.D.

Provider Business Mailing Address
First Line	:	2865 SHIMMERING BAY ST
Second Line	:
City	:	LAUGHLIN
State	:	NV
Zip	:	89029-1252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2681 HIGHWAY 95
Second Line	:	SUITE 100
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8490
Country	:	US
Telephone Number	:	928-763-9999
Fax Number	:	928-763-9931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	12/07/2009

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