Provider Demographics
NPI:1548457617
Name:HILL, BRUCE D (PHD, LMFT, CEAP)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:HILL
Suffix:
Gender:M
Credentials:PHD, LMFT, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 S MARICOPA ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6796
Mailing Address - Country:US
Mailing Address - Phone:907-388-5864
Mailing Address - Fax:
Practice Address - Street 1:310 W BIRCH AVE STE 5
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4411
Practice Address - Country:US
Practice Address - Phone:907-388-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1234Other1234