1508375320 NPI number — MRS. AUTUMN Y. BRUCE-SCOTT LPCC

Table of content: MRS. AUTUMN Y. BRUCE-SCOTT LPCC (NPI 1508375320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508375320 NPI number — MRS. AUTUMN Y. BRUCE-SCOTT LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUCE-SCOTT
Provider First Name:
AUTUMN
Provider Middle Name:
Y.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508375320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 DOUGLAS BLVD # 85-427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95661-3811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-365-2046
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 AUBURN BLVD STE 1200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95841-4153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-418-0828
Provider Business Practice Location Address Fax Number:
916-418-0838
Provider Enumeration Date:
09/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  12630 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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