MEDICARE: DR. RANDAL CLAY BRUCE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	6301007332	MI
2	103TC0700X	Clinical Psychologist	6301007332	MI
3	103G00000X	Clinical Neuropsychologist	6301007332	MI

General Provider Information

NPI Number	:	1306834551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDAL CLAY BRUCE PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 3380
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48333-3380
Country	:	US
Telephone Number	:	248-624-8181
Fax Number	:	855-624-8161

Provider Business Practice Location Address
First Line	:	37000 GRAND RIVER AVE STE 325
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-2868
Country	:	US
Telephone Number	:	248-624-8181
Fax Number	:	855-624-8161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	05/21/2023

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