Ted Terry Bruce, MSW LICSW
Individual provider Active NPI Counseling Psychologist · Glendale, WI
NPI 1043376734 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043376734
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counseling Psychologist 103TC1900X
- License
- 3906-123 (WI)
- Practice address
- 6110 N Port Washington Rd
Glendale, WI 53217 - Phone
- (414) 332-7400
- Fax
- (414) 963-6866
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3906-123 | WI | MD | Counseling Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 3906-123 | WI | Yes |
Addresses
Primary practice location
6110 N Port Washington Rd
Glendale, WI 53217
Mailing address
6110 N Port Washington Rd
Glendale, WI 53217
Phone (414) 332-3322
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All providers in Glendale, WI · Counseling Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.