Provider Demographics
NPI:1699464479
Name:BRUCE, AMBRA
Entity type:Individual
Prefix:
First Name:AMBRA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N SCHOOL AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5126
Mailing Address - Country:US
Mailing Address - Phone:479-866-7309
Mailing Address - Fax:
Practice Address - Street 1:109 N SCHOOL AVE APT 7
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5126
Practice Address - Country:US
Practice Address - Phone:479-866-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9135-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical