Active NPI
Bruce Edstrom, L.P.C., L.M.F.T.
- Professional Counselor
- Dallas, TX
National Provider Identifier
1972899631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 10870
- Practice address
- 9401 LBJ Fwy Ste 420
Dallas, TX 75243-4540 - Phone
- (469) 688-3605
- NPI assigned
- Jun 21, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 10870 | TX | Primary |
| Marriage & Family Therapist | 106H00000X | 3880 | TX |
Addresses
Primary practice location
9401 LBJ Fwy Ste 420
Dallas, TX 75243-4540
Mailing address
9401 LBJ Fwy Ste 420
Dallas, TX 75243-4540
Phone (469) 688-3605
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10870 | TX | MD | Professional Counselor |
| 3880 | TX | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308614400000",
"number": "1972899631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9401 LBJ FWY STE 420",
"city": "DALLAS",
"state": "TX",
"postal_code": "752434540",
"telephone_number": "469-688-3605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9401 LBJ FWY STE 420",
"city": "DALLAS",
"state": "TX",
"postal_code": "752434540",
"telephone_number": "469-688-3605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDSTROM",
"first_name": "BRUCE",
"credential": "L.P.C., L.M.F.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-21",
"last_updated": "2011-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "10870",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "TX",
"license": "3880",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
- Philip Marshall Edmundson, M.D.
- Brett Ednie, D.C.
- Eds-I Practices of California a Medical Corporation
- Eds-I Practices of Texas PA
- Edson H Cheung MD PA
- Educare Community Living Corporation - Texas
- Educare Community Living Corporation - Texas
- Educare Community Living Corporation - Texas
- Educare Community Living Corporation - Texas
- Edward Genecov DDS Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.