Provider Demographics
NPI:1972538304
Name:PACKEL, BRUCE (MFT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:PACKEL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:PACKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91951-0703
Mailing Address - Country:US
Mailing Address - Phone:619-336-6674
Mailing Address - Fax:
Practice Address - Street 1:2313 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1105
Practice Address - Country:US
Practice Address - Phone:619-260-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health