Baxley, Bruce Carroll

Baxley, Bruce Carroll is an sole proprietor health care provider with primary practice located at 4405 Manchester Ave Ste 206 , Encinitas CA 92024-7902. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Baxley, Bruce Carroll can be contacted via phone (858) 271-3060.

Contact Information

Primary practice address
4405 Manchester Ave Ste 206 Encinitas CA 92024-7902
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY6399 California

Profile Details

NPI number 1154477362
LBN Legal business name Baxley, Bruce Carroll
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 28th, 2007
Last updated Sep 30th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154477362 NPPES
California MEDICAID PSY063990

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