MEDICARE: ELAINE LA BRUYERE

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	101YP2500X	Professional Counselor	91876	TX

General Provider Information

NPI Number	:	1437958287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE LA BRUYERE

Provider Business Mailing Address
First Line	:	8150 N CENTRAL EXPY STE 1625
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1806
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:	214-530-0021

Provider Business Practice Location Address
First Line	:	13612 MIDWAY RD STE 605
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4324
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:	214-530-0021

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

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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Directions to “ ELAINE LA BRUYERE ” Practice Location

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