Provider Demographics
NPI:1437987708
Name:BRUCE, GRACE NOELLE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:NOELLE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 HIGHWAY 109 N UNIT 1306
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-3014
Mailing Address - Country:US
Mailing Address - Phone:615-808-1305
Mailing Address - Fax:
Practice Address - Street 1:4721 TROUSDALE DR # 10
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1322
Practice Address - Country:US
Practice Address - Phone:615-852-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician