Provider Demographics
NPI:1285670703
Name:BRU, TRACY K (MS, LPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:K
Last Name:BRU
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 S STAPLES ST
Mailing Address - Street 2:S-203
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5201
Mailing Address - Country:US
Mailing Address - Phone:361-852-9665
Mailing Address - Fax:361-852-2794
Practice Address - Street 1:5959 S STAPLES ST STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3844
Practice Address - Country:US
Practice Address - Phone:361-442-4024
Practice Address - Fax:361-806-9491
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152505703Medicaid