Provider Demographics
NPI:1861674608
Name:CALEY-BRUCE, MARY MARGARET (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:CALEY-BRUCE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10730 POTRANCO RD
Mailing Address - Street 2:SUITE 122-264
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3327
Mailing Address - Country:US
Mailing Address - Phone:210-219-6163
Mailing Address - Fax:866-223-7207
Practice Address - Street 1:114 N. ELLISON DR.
Practice Address - Street 2:SUITE 416
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-5019
Practice Address - Country:US
Practice Address - Phone:210-219-6163
Practice Address - Fax:866-223-7207
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX61796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1938821-01Medicaid