Provider Demographics
NPI:1255416574
Name:BOSWELL, BRUCE (LPC)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271416
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1416
Mailing Address - Country:US
Mailing Address - Phone:361-334-1136
Mailing Address - Fax:361-334-1574
Practice Address - Street 1:4925 EVERHART RD STE 103
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-806-2600
Practice Address - Fax:361-806-2624
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17545101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1509028-02Medicaid
TX150902801Medicaid