Provider Demographics
NPI:1053757252
Name:BRULE COUNSELING, LLC
Entity type:Organization
Organization Name:BRULE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:BOSUSTOW
Authorized Official - Last Name:BRULE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-953-3929
Mailing Address - Street 1:1210 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3573
Mailing Address - Country:US
Mailing Address - Phone:541-953-3929
Mailing Address - Fax:541-343-2663
Practice Address - Street 1:1210 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3573
Practice Address - Country:US
Practice Address - Phone:541-953-3929
Practice Address - Fax:541-343-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1832251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health