Provider Demographics
NPI:1871774927
Name:BRUCE, MISTY DAWN (LPC)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
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 1:201 W LAKEWAY RD STE 1004
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6349
Mailing Address - Country:US
Mailing Address - Phone:307-387-9850
Mailing Address - Fax:307-387-9890
Practice Address - Street 1:201 W LAKEWAY RD STE 700
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6346
Practice Address - Country:US
Practice Address - Phone:307-387-9850
Practice Address - Fax:307-387-9860
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1068101Y00000X
WY366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health