Provider Demographics
NPI:1386396562
Name:BRUGGMAN, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BRUGGMAN
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 1:13031 SUNSHINE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76534-5081
Mailing Address - Country:US
Mailing Address - Phone:254-913-3413
Mailing Address - Fax:
Practice Address - Street 1:13031 SUNSHINE RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:TX
Practice Address - Zip Code:76534-5081
Practice Address - Country:US
Practice Address - Phone:254-913-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical