Individual
BRUCE EDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C., L.M.F.T.
Contact information
Practice address
9401 LBJ FWY STE 420, DALLAS, TX 75243-4540
(469) 688-3605
Mailing address
9401 LBJ FWY STE 420, DALLAS, TX 75243-4540
(469) 688-3605
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
10870
TX
106H00000X
Marriage & Family Therapist
3880
TX
Other
Enumeration date
06/21/2011
Last updated
06/21/2011
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