Provider Demographics
NPI:1669763306
Name:BRUCE, TINA (LPC)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SERGEANT PRENTISS DR
Mailing Address - Street 2:STE 102
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4791
Mailing Address - Country:US
Mailing Address - Phone:601-653-4581
Mailing Address - Fax:
Practice Address - Street 1:114 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5104
Practice Address - Country:US
Practice Address - Phone:601-653-4581
Practice Address - Fax:601-653-4582
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 261QM0801X, 101YP2500X, 251B00000X, 251S00000X
LA5910101YM0800X
TX83432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health