Basic Information
| Provider Information | |||||||||
| NPI: | 1871610121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUCH | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10433 PAMPLONA ST NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871145607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057302453 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2612 TEXAS ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871104684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058301871 | ||||||||
| FaxNumber: | 5058300040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | T-0099251 | NM | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 0118111 | NM | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | CMF0118111 | NM | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.