Provider Demographics
NPI:1386799385
Name:KUGLER, BRUCE D (PHD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:KUGLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:BERTHOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80513
Mailing Address - Country:US
Mailing Address - Phone:303-919-3579
Mailing Address - Fax:970-532-4891
Practice Address - Street 1:1332 LINDEN STREET
Practice Address - Street 2:STE #3
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-919-3579
Practice Address - Fax:970-532-4891
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25904345Medicaid
CO83746Medicare ID - Type Unspecified