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NPI Code Detail

MEDICARE: KRISTEN NICOLE BRUCE LPC

MEDICARE: KRISTEN NICOLE BRUCE LPC
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
1171M00000XCase Manager/Care Coordinator
2101Y00000XCounselorAR
3101YP2500XProfessional Counselor
4101YP2500XProfessional CounselorP2005014AR

General Provider Information

NPI Number : 1760803241
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN NICOLE BRUCE LPC
Provider Business Mailing Address
First Line : 1600 ALDERSGATE RD STE 200
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-6676
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 613 N FISHER ST
Second Line :
City : JONESBORO
State : AR
Zip : 72401-2152
Country : US
Telephone Number : 870-910-3757
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2013
Last Update Date : 08/09/2023

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