Provider Demographics
NPI:1558243642
Name:BRUCKNER COUNSELING
Entity type:Organization
Organization Name:BRUCKNER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-340-6944
Mailing Address - Street 1:3651 MARS HILL RD STE 500B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5988
Mailing Address - Country:US
Mailing Address - Phone:706-223-0908
Mailing Address - Fax:706-310-8113
Practice Address - Street 1:3651 MARS HILL RD STE 500B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5988
Practice Address - Country:US
Practice Address - Phone:706-223-0908
Practice Address - Fax:706-310-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty