Provider Demographics
NPI:1649326190
Name:BRUCE, DEBRA K (QMHA, MFA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:BRUCE
Suffix:
Gender:F
Credentials:QMHA, MFA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:K
Other - Last Name:BRUCE-MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA, MFA
Mailing Address - Street 1:2346 NW GLISAN ST
Mailing Address - Street 2:# 55
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3449
Mailing Address - Country:US
Mailing Address - Phone:503-756-5653
Mailing Address - Fax:
Practice Address - Street 1:2330 NE SISKIYOU ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2471
Practice Address - Country:US
Practice Address - Phone:503-528-0757
Practice Address - Fax:503-528-0764
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator