Doctor Name: | TRACY K BRU |
NPI Number: | 1285670703 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC |
License Number: | 17669 |
Business Practice Address: | 1020h S 14th St Kingsville, TX - 783636422 |
Business Phone Number: | 3615926058 |
Business Fax Number: | 3615927843 |
Mailing Address: | 3833 S Staples St, S-203 CORPUS CHRISTI |
State: | TX |
Postal Code: | 784115201 |
Phone Number: | 3618529665 |
Fax Number: | 3618522794 |
NPI Enumeration Date: | 06/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 17669 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |