MEDICARE: MS. STEPHANIE L BRUCE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497137954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE L BRUCE

Provider Business Mailing Address
First Line	:	55A WOODY ACRES DR
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-3213
Country	:	US
Telephone Number	:	334-614-2406
Fax Number	:

Provider Business Practice Location Address
First Line	:	55A WOODY ACRES DR
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-3213
Country	:	US
Telephone Number	:	334-614-2406
Fax Number	:

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/22/2015

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