Baxley, Bruce Carroll
Baxley, Bruce Carroll is an sole proprietor health care provider with primary practice located at 4405 Manchester Ave Ste 206 , Encinitas CA 92024-7902. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Baxley, Bruce Carroll can be contacted via phone (858) 271-3060.Contact Information
Primary practice address
4405 Manchester Ave Ste 206
Encinitas CA 92024-7902
Phone: (858) 271-3060
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY6399 | California |
Profile Details
| NPI number | 1154477362 |
|---|---|
| LBN Legal business name | Baxley, Bruce Carroll |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 28th, 2007 |
| Last updated | Sep 30th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154477362 | NPPES |
| California | MEDICAID | PSY063990 |
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