Provider Demographics
NPI:1578233672
Name:BRUCE, PAIGE C (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:C
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2205
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-2205
Mailing Address - Country:US
Mailing Address - Phone:928-699-3801
Mailing Address - Fax:
Practice Address - Street 1:101 2ND AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8551
Practice Address - Country:US
Practice Address - Phone:928-699-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-98888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional