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BROOKE D BRUCE PC-IT

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1700388782

Individual Registrant:
 BROOKE D BRUCE PC-IT
Gender: F
Not Sole Proprietor

Location and contact information for practice:
571 COUNTY ROAD A  GREEN LAKE, WI 54941-8630 US
Tel: 920-294-4070  Fax: 920-294-4139

Contact information for business:
PO BOX 588  GREEN LAKE, WI 54941-0588 US
Tel: 920-294-4070  Fax: 920-294-4139

Registration Information:
NPI: 1700388782
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
WI3838-226

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSE3838-226WI01




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