Provider Demographics
NPI:1669598728
Name:ERVIN, BRUCE DAVID (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DAVID
Last Name:ERVIN
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9952 NORD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2339
Mailing Address - Country:US
Mailing Address - Phone:952-956-0076
Mailing Address - Fax:
Practice Address - Street 1:7400 METRO BLVD STE 220
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2321
Practice Address - Country:US
Practice Address - Phone:952-345-4510
Practice Address - Fax:952-345-4518
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist