MEDICARE: MRS. AUTUMN Y. BRUCE-SCOTT LPCC

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	12630	CA

General Provider Information

NPI Number	:	1508375320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUTUMN Y. BRUCE-SCOTT LPCC

Provider Business Mailing Address
First Line	:	1911 DOUGLAS BLVD # 85-427
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3811
Country	:	US
Telephone Number	:	916-365-2046
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 AUBURN BLVD STE 1200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-4153
Country	:	US
Telephone Number	:	916-418-0828
Fax Number	:	916-418-0838

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

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	03/16/2023

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